Surgical salvage of renal cell carcinoma recurrence after thermal ablative therapy

Thermal ablative therapies, including cryoablation and radio frequency ablation, have become viable options for the management of small renal tumors. However, initial data have suggested higher local recurrence rates for ablation compared to partial nephrectomy. We evaluated options for salvage of ipsilateral tumor recurrence after previous ablation.

Records of renal surgeries performed at our institution between September 1997 and December 2006 were reviewed to identify patients with ipsilateral tumor recurrence after radio frequency ablation or cryoablation, and clinical characteristics and treatment were defined.

Recurrence rates at our hospital were 13 of 175 (7.4%) after cryoablation and 26 of 104 (25%) after radio frequency ablation, and 3 additional cases of post-cryoablation recurrence were referred from elsewhere. Overall repeat ablation was performed in 26 patients who experienced post-ablative recurrence. However, 12 patients (33%) were not candidates for repeat ablation due to large tumor size, disease progression or repeat ablative failure. In this group 1 patient received systemic therapy, 1 refused further treatment and 10 underwent attempted extirpation. Partial nephrectomy was only possible in 2 patients and both required an open approach. Remaining patients were treated with radical nephrectomy (7) or had the procedure aborted due to strong patient preference to avoid dialysis (1). Laparoscopic surgery was only possible in 4 cases. Extensive perinephric scarring was encountered in all salvage operations following cryoablation.

Primary thermal ablation for small renal masses may preclude or complicate subsequent surgical salvage. Cryoablation in particular can lead to extensive perinephric fibrosis which can complicate attempts at salvage. Appropriate patient selection for thermal ablation remains of paramount importance.