Skip to main content
SpringerLink
Log in

Safety of percutaneous renal cryoablation: an international multicentre experience from the EuRECA retrospective percutaneous database

  • Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To investigate the safety profile of percutaneous cryoablation of renal tumours < 7 cm, utilising data extracted from an international multicentre registry.

Materials and methods

A retrospective review of all immediate and delayed complications from a multicentre database was performed and was categorised according to the Clavien-Dindo classification. Statistical analysis was performed for both overall complications (all Clavien-Dindo) and major complications (Clavien-Dindo 3 to 5). The following criteria were identified as potential predictive factors for complications: centre number, modality of image guidance, tumour size (≤ 4 cm vs. > 4 cm), number of tumours treated in the same session (1 vs. > 1) and tumour histology.

Results

A total of 713 renal tumours underwent ablation in 647 individual sessions. In 596 of the cases, one tumour was treated; in the remaining 51 cases, several tumours were treated per session. Mean lesion size was 2.8 cm. Fifty-four complications (Clavien-Dindo 1 to 5) occurred as a result of the 647 procedures, corresponding to an overall complication rate of 8.3%. The most frequent complication was bleeding (3.2%), with 9 cases (1.4%) requiring subsequent treatment. The rate of major complication was 3.4%. The only statistically significant prognostic factor for a major complication was a tumour size > 4 cm.

Conclusion

Percutaneous renal cryoablation is associated with a low rate of complications. Tumours measuring more than 4 cm are associated with a higher risk of major complications.

Key Points

• Percutaneous kidney cryoablation has a low rate of complications.

• Bleeding is the most frequent complication.

• A tumour size superior to 4 cm is a predictive factor of major complication.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

CBCT:

Cone-beam CT

CT:

Computed tomography

EuRECA:

European Registry for Renal Cryoablation

MRI:

Magnetic resonance imaging

RCC:

Renal cell carcinomas

RFA:

Radiofrequency ablation

References

  1. Uhlig J, Strauss A, Rücker G et al (2018) Partial nephrectomy versus ablative techniques for small renal masses: a systematic review and network meta-analysis. Eur Radiol. https://doi.org/10.1007/s00330-018-5660-3

  2. Thompson RH, Atwell T, Schmit G et al (2015) Comparison of partial nephrectomy and percutaneous ablation for cT1 renal masses. Eur Urol 67(2):252–259. https://doi.org/10.1016/j.eururo.2014.07.021

    Article  PubMed  Google Scholar 

  3. Rivero JR, De La Cerda J 3rd, Wang H et al (2018) Partial nephrectomy versus thermal ablation for clinical stage T1 renal masses: systematic review and meta-analysis of more than 3,900 patients. J Vasc Interv Radiol 29(1):18–29. https://doi.org/10.1016/j.jvir.2017.08.013

    Article  PubMed  Google Scholar 

  4. Ismail M, Nielsen TK, Lagerveld B et al (2018) Renal cryoablation: multidisciplinary, collaborative and perspective approach. Cryobiology 83:90–94. https://doi.org/10.1016/j.cryobiol.2018.06.002

    Article  PubMed  Google Scholar 

  5. Patel N, King AJ, Breen DJ (2016) Percutaneous image-guided cryoablation of small renal masses. Abdom Radiol (NY) 41(4):754–766. https://doi.org/10.1007/s00261-016-0682-2

    Article  Google Scholar 

  6. Buy X, Lang H, Garnon J, Gangi A (2011) Percutaneous ablation of renal tumors: radiofrequency ablation or cryoablation? Journal de Radiologie 92(9):774–788. https://doi.org/10.1016/j.jradio.2011.07.016

  7. Buy X, Lang H, Garnon J, Sauleau E, Roy C, Gangi A (2013) Percutaneous renal cryoablation: prospective experience treating 120 consecutive tumors. AJR Am J Roentgenol 201(6):1353–1361. https://doi.org/10.2214/AJR.13.11084

    Article  PubMed  Google Scholar 

  8. Schmit GD, Atwell TD, Callstrom MR et al (2010) Percutaneous cryoablation of renal masses >or=3 cm: efficacy and safety in treatment of 108 patients. J Endourol 24(8):1255–1262. https://doi.org/10.1089/end.2009.0328

    Article  PubMed  Google Scholar 

  9. Georgiades CS, Rodriguez R (2014) Efficacy and safety of percutaneous cryoablation for stage 1A/B renal cell carcinoma: results of a prospective, single-arm, 5-year study. Cardiovasc Intervent Radiol 37(6):1494–1499. https://doi.org/10.1007/s00270-013-0831-8

    Article  PubMed  Google Scholar 

  10. Nielsen TK, Lagerveld BW, Keeley F et al (2017) Oncological outcomes and complication rates after laparoscopic-assisted cryoablation: a European Registry for Renal Cryoablation (EuRECA) multi-institutional study. BJU Int 119(3):390–395. https://doi.org/10.1111/bju.13615

    Article  PubMed  Google Scholar 

  11. Georgiades C, Rodriguez R, Azene E et al (2013) Determination of the nonlethal margin inside the visible “ice-ball” during percutaneous cryoablation of renal tissue. Cardiovasc Intervent Radiol 36(3):783–790. https://doi.org/10.1007/s00270-012-0470-5

    Article  PubMed  Google Scholar 

  12. Gage AA, Baust J (1998) Mechanisms of tissue injury in cryosurgery. Cryobiology 37(3):171–186

    Article  CAS  Google Scholar 

  13. Klossner DP, Robilotto AT, Clarke DM et al (2007) Cryosurgical technique: assessment of the fundamental variables using human prostate cancer model systems. Cryobiology 55(3):189–199

    Article  Google Scholar 

  14. Breen DJ, Bryant TJ, Abbas A et al (2013) Percutaneous cryoablation of renal tumours: outcomes from 171 tumours in 147 patients. BJU Int 112(6):758–765. https://doi.org/10.1111/bju.12122

    Article  PubMed  Google Scholar 

  15. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  Google Scholar 

  16. Schmit GD, Schenck LA, Thompson RH et al (2014) Predicting renal cryoablation complications: new risk score based on tumor size and location and patient history. Radiology 272(3):903–910. https://doi.org/10.1148/radiol.14132548

    Article  PubMed  Google Scholar 

  17. Breen DJ, King AJ, Patel N, Lockyer R, Hayes M (2018) Image-guided cryoablation for sporadic renal cell carcinoma: three- and 5-year outcomes in 220 patients with biopsy-proven renal cell carcinoma. Radiology 7:180249. https://doi.org/10.1148/radiol.2018180249

    Article  Google Scholar 

  18. Atwell TD, Carter RE, Schmit GD et al (2012) Complications following 573 percutaneous renal radiofrequency and cryoablation procedures. J Vasc Interv Radiol 23(1):48–54. https://doi.org/10.1016/j.jvir.2011.09.008

    Article  PubMed  Google Scholar 

  19. Kakarala B, Frangakis CE, Rodriguez R, Georgiades CS (2016) Hemorrhagic complications of percutaneous cryoablation for renal tumors: results from a 7-year prospective study. Cardiovasc Intervent Radiol 39(11):1604–1610. https://doi.org/10.1007/s00270-016-1419-x

    Article  PubMed  Google Scholar 

  20. Wah TM, Irving HC, Gregory W, Cartledge J, Joyce AD, Selby PJ (2014) Radiofrequency ablation (RFA) of renal cell carcinoma (RCC): experience in 200 tumours. BJU Int 113(3):416–428. https://doi.org/10.1111/bju.12349

    Article  PubMed  Google Scholar 

  21. Braak SJ, van Melick HH, Onaca MG, van Heesewijk JP, van Strijen MJ (2012) 3D cone-beam CT guidance, a novel technique in renal biopsy--results in 41 patients with suspected renal masses. Eur Radiol 22(11):2547–2552. https://doi.org/10.1007/s00330-012-2498-y

    Article  PubMed  PubMed Central  Google Scholar 

  22. Koch G, Garnon J, Tsoumakidou G et al (2018) Adrenal biopsy under wide-bore MR imaging guidance. J Vasc Interv Radiol 29(2):285–290. https://doi.org/10.1016/j.jvir.2017.04.023

    Article  PubMed  Google Scholar 

  23. Bagley DH, Terrill R, Javadpour N, Beazley RM (1976) Cryosurgery of the ureter in dogs. Invest Urol 14(3):241–245

    CAS  PubMed  Google Scholar 

  24. West B, Keheila M, Smith JC et al (2018) Efficacy of antegrade and retrograde warm saline pyeloperfusion during renal cryoablation for ureteral preservation. Turk J Urol 44(2):142–147. https://doi.org/10.5152/tud.2017.44380

    Article  PubMed  PubMed Central  Google Scholar 

  25. Mauri G, Nicosia L, Varano GM et al (2017) Tips and tricks for a safe and effective image-guided percutaneous renal tumour ablation. Insights Imaging 8(3):357–363. https://doi.org/10.1007/s13244-017-0555-4

    Article  PubMed  PubMed Central  Google Scholar 

  26. Krokidis ME, Orsi F, Katsanos K, Helmberger T, Adam A (2017) CIRSE guidelines on percutaneous ablation of small renal cell carcinoma. Cardiovasc Intervent Radiol 40(2):177–191. https://doi.org/10.1007/s00270-016-1531-y

    Article  PubMed  Google Scholar 

  27. Azevedo AAP, Rahal A Junior, Falsarella PM et al (2018) Image-guided percutaneous renal cryoablation: five years experience, results and follow-up. Eur J Radiol 100:14–22. https://doi.org/10.1016/j.ejrad.2018.01.001

    Article  PubMed  Google Scholar 

  28. Haddad MM, Schmit GD, Kurup AN et al (2018) Percutaneous cryoablation of solitary, sporadic renal cell carcinoma: outcome analysis based on clear-cell versus papillary subtypes. J Vasc Interv Radiol 29(8):1122–1126. https://doi.org/10.1016/j.jvir.2018.02.029

    Article  PubMed  Google Scholar 

  29. Yang B, Autorino R, Remer EM et al (2013) Probe ablation as salvage therapy for renal tumors in von Hippel-Lindau patients: the Cleveland Clinic experience with 3 years follow-up. Urol Oncol 31(5):686–692. https://doi.org/10.1016/j.urolonc.2011.05.008

    Article  PubMed  Google Scholar 

Download references

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l’hôpital, 67096, Strasbourg Cedex, France

    J. Garnon, R. L. Cazzato & P. Auloge

  2. Department of Radiology, St. Antonius Hospital, Niewegein, the Netherlands

    M. J. Van Strijen

  3. Department of Urology, Aarhus University Hospital, Aarhus, Denmark

    T. K. Nielsen

  4. Department of Radiology, University Hospital Southampton NHS Trust, Tremona Road, Southampton, SO16 6YD, UK

    A. J. King & D. J. Breen

  5. Department of Urology, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1091 AC, Amsterdam, Netherlands

    A. D. Montauban Van Swijndregt & B. W. Lagerveld

  6. Clinical Investigation Center INSERM 1414, University Hospital of Rennes and University of Rennes, Rennes, France

    C. Rousseau

  7. Department of Radiology, Guy’s and St. Thomas’ Hospitals NHS Foundation Trust, London, UK

    D. Dalili

  8. Department of Urology, Bristol Urological Institute, Bristol, UK

    F. X. Keeley Jr

Authors
  1. J. Garnon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. J. Van Strijen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. T. K. Nielsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. J. King
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. D. Montauban Van Swijndregt
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. R. L. Cazzato
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. P. Auloge
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. C. Rousseau
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. D. Dalili
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. F. X. Keeley Jr
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. B. W. Lagerveld
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. D. J. Breen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Garnon.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Julien Garnon—University Hospital of Strasbourg.

Conflict of interest

Dr. Garnon is a proctor for BTG Galil and received fees for oral presentation for Medtronic and Canon. Dr. Van Strijen, Lagerweld and Breen are proctors for BTG Galil. All other authors have no conflict of interest.

Statistics and biometry

Dr. Rousseau has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was not required because of the retrospective design of the study.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in:

• Buy X, Lang H, Garnon J, Sauleau E, Roy C, Gangi A. Percutaneous renal cryoablation: prospective experience treating 120 consecutive tumors. AJR Am J Roentgenol. 2013 Dec;201(6):1353–61. https://doi.org/10.2214/AJR.13.11084.

• Breen DJ, Bryant TJ, Abbas A, Shepherd B, McGill N, Anderson JA, Lockyer RC,Hayes MC, George SL. Percutaneous cryoablation of renal tumours: outcomes from 171 tumours in 147 patients. BJU Int. 2013 Oct;112(6):758–65. https://doi.org/10.1111/bju.12122.

Methodology

• retrospective

• observational

• multicentre study

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Garnon, J., Van Strijen, M.J., Nielsen, T.K. et al. Safety of percutaneous renal cryoablation: an international multicentre experience from the EuRECA retrospective percutaneous database. Eur Radiol 29, 6293–6299 (2019). https://doi.org/10.1007/s00330-019-06191-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-019-06191-y

Keywords

Search

Navigation