Presentation Authors: Takafumi Yanagisawa*, Jun Miki, Takayuki Sano, Takashi Otsuka, Yuki Enei, Kosuke Iwatani, Daigo Kobayashi, Mahito Atsuta, Seiro Tanaka, Koki Obayashi, Kenji Motohashi, Keitaro Enoki, Shimizu Kanichiro, Kashiwa, Japan, Shin Egawa, Tokyo, Japan
Introduction: Percutaneous cryoablation(PCA) is mentioned as only option for cT1 renal tumor because recurrence rate is relatively higher than that in partial nephrectomy. Salvage cryoablation can be performed for recurrent tumor, however its utility is unclear. We evaluated the utility and safety in patients treated with salvage cryoablation for recurrent tumor after primary PCA for cT1 renal tumor.
Methods: We retrospectively analyzed the record of the patients who underwent PCA in our institution between November 2011 and March 2018. First, we analyzed overall survival(OS), cancer specific survival(CSS) and local recurrence free survival(L-RFS) in primary PCA using the Kaplan-Meier method and compared with log-rank tests. Second, we analyzed perioperative outcome and renal function and oncological outcome of salvage PCA compared with primary PCA.
Results: A total 189 tumors underwent PCA (Primary: n=171, Salvage: n=18). In Primary PCA group, 13(7.6%) residues and 10(5.8%) recurrences were later diagnosed. The median follow-up period was 26 months. The 3-year OS and CSS were 97.3%(95%CI:91.5-99.2) and 99.4%(95%CI:95.5-99.9) respectively. The 3-year L-RFS was 85.7%(95%CI:78.0-90.9). In multivariate analysis by cox proportional hazard model, age and high R.E.N.A.L score (>10) were independent prognostic factor for recurrence. In comparing Primary with Salvage PCA, perioperative overall complication rate had no significant difference in both groups. The 3-year L-RFS was no significant difference, Primary: 85.7%(78.0-90.9) vs. Salvage: 80.8%(41.0-95.0, P=0.854). Two patients in Salvage group had recurrence at 6 and 23 months respectively and underwent a third salvage PCA successfully. All tumors in Salvage group were able to be locally controlled.
Conclusions: Although PCA has higher local recurrence rate, local control can be obtained by salvage PCA. Salvage PCA after primary cryoablation failure is feasible, has a low complication rate, and acceptable mid-term oncologic outcomes. Further studies with durable follow-up are required.