1523 MANAGEMENT OF RECURRENCES FOLLOWING CRYOABLATION OR RADIOFREQUENCY ABLATION (RFA) OF RENAL CORTICAL TUMORS (2011)

You have accessJournal of UrologyKidney Cancer: Localized1 Apr 20111523 MANAGEMENT OF RECURRENCES FOLLOWING CRYOABLATION OR RADIOFREQUENCY ABLATION (RFA) OF RENAL CORTICAL TUMORS Jay Raman, Chester Donnally, W. Bruce Shingleton, Daniel Kaplon, Stephen Nakada, David Werle, Joseph Pettus, Ronald Zagoria, Ali Ordonez, Jaime Landman, Amin Herati, Benjamin Lee, Kamran Ahrar, Surena Matin, Charles Moore, Raymond Leveillee, Michael Louie, Ralph Clayman, and Jeffrey Cadeddu Jay RamanJay Raman Hershey, PA More articles by this author , Chester DonnallyChester Donnally Dallas, TX More articles by this author , W. Bruce ShingletonW. Bruce Shingleton Chapel Hill, NC More articles by this author , Daniel KaplonDaniel Kaplon Madison, WI More articles by this author , Stephen NakadaStephen Nakada Madison, WI More articles by this author , David WerleDavid Werle Winston Salem, NC More articles by this author , Joseph PettusJoseph Pettus Winston Salem, NC More articles by this author , Ronald ZagoriaRonald Zagoria Winston Salem, NC More articles by this author , Ali OrdonezAli Ordonez New York, NY More articles by this author , Jaime LandmanJaime Landman New York, NY More articles by this author , Amin HeratiAmin Herati Long Island, NY More articles by this author , Benjamin LeeBenjamin Lee Long Island, NY More articles by this author , Kamran AhrarKamran Ahrar Houston, TX More articles by this author , Surena MatinSurena Matin Houston, TX More articles by this author , Charles MooreCharles Moore Miami, FL More articles by this author , Raymond LeveilleeRaymond Leveillee Miami, FL More articles by this author , Michael LouieMichael Louie Irvine, CA More articles by this author , Ralph ClaymanRalph Clayman Irvine, CA More articles by this author , and Jeffrey CadedduJeffrey Cadeddu Dallas, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1516AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Thermal ablation has assumed a role in the management of renal masses. Recurrences are reported to occur in 5–10% of cases. Management options for these recurrences are incompletely defined and include surveillance, repeat ablation, or surgical extirpation. We present a multi-institutional experience for management of recurrences following renal ablation. METHODS Prospectively maintained databases from 9 centers were reviewed to identify 1265 patients (with 1385 renal tumors) who underwent cryoablation or radiofrequency ablation (RFA). Ablation was performed via laparoscopic or percutaneous approaches. Recurrences were classified into one of 3 categories: 1) incomplete primary ablation (<3 months from initial ablation); 2) ablation zone recurrence; and 3) metastatic/distant/extra-renal disease. RESULTS Overall, 77 patients (6.1%) developed a radiographic recurrence at a mean interval of 13.7 months (range, 1–65) post-ablation. Recurrence rates were 6.6% (58/875) for RFA and 4.9% (19/390) for cryoablation (p=0.22). For patients with recurrences, mean pre-ablation lesion size was 3.3cm and two-thirds of these tumors were endophytic. The distribution of initial ablation recurrences included 47 incomplete primary ablations, 29 ablation zone recurrences, and 1 metastasis. Management is highlighted in the figure. In the 16 patients requiring surgical extirpation, final pathology was renal cell carcinoma (RCC) in 10, necrosis/fibrosis in 4, oncocytoma in 1, and AML in 1. Of the 10 RCC specimens, histological subtype was 8 clear cell and 2 papillary with a stage distribution of pT1a in 7 and pT3a in 3. At mean of 28.0 months (range, 3 to 69), 53 patients had no evidence of disease, 16 were alive with disease, 4 had died of metastatic RCC, and 4 died of other causes. The actuarial cancer-specific and overall survival in this select cohort of patients was 94.8% and 89.6%, respectively, at last follow-up. CONCLUSIONS Recurrent disease following thermal ablation occurred in 6% of cases. Salvage ablative procedures successfully managed recurrences in 41 of 77 (53%) cases. Nonetheless, approximately 20% of patients with renal recurrences required extirpative surgery. Delineation of management strategies for recurrent disease allows for better patient counseling prior to primary ablation therapy. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e611 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jay Raman Hershey, PA More articles by this author Chester Donnally Dallas, TX More articles by this author W. Bruce Shingleton Chapel Hill, NC More articles by this author Daniel Kaplon Madison, WI More articles by this author Stephen Nakada Madison, WI More articles by this author David Werle Winston Salem, NC More articles by this author Joseph Pettus Winston Salem, NC More articles by this author Ronald Zagoria Winston Salem, NC More articles by this author Ali Ordonez New York, NY More articles by this author Jaime Landman New York, NY More articles by this author Amin Herati Long Island, NY More articles by this author Benjamin Lee Long Island, NY More articles by this author Kamran Ahrar Houston, TX More articles by this author Surena Matin Houston, TX More articles by this author Charles Moore Miami, FL More articles by this author Raymond Leveillee Miami, FL More articles by this author Michael Louie Irvine, CA More articles by this author Ralph Clayman Irvine, CA More articles by this author Jeffrey Cadeddu Dallas, TX More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...