Percutaneous Cryoablation of Renal Cell Carcinoma with Sinus Vein Involvement Based on Preprocedural Imaging

To assess feasibility, safety, and oncologic outcomes of cryoablation in treatment of renal cell carcinoma (RCC) with extension into adjacent renal sinus vein.

Review of an internally maintained renal ablation registry identified 7 patients (4 men and 3 women; median age 62 y; age range, 45-91 y) who underwent percutaneous cryoablation of RCC with imaging consistent with extension of tumor into an immediately adjacent renal sinus vein. Four of 7 (57%) patients had recurrent tumors following prior partial nephrectomy. Three of 7 patients (43%) had solitary kidneys.

Median tumor size was 4.3 cm (range, 1.9-5.0 cm). Biopsy showed RCC in 6 of 7 patients. Technical success was achieved in 6 of 7 tumors (86%) There was a single Clavien grade 3 major complication. Median hospital stay was 1 night (range, 1-3 nights). Follow-up imaging performed in the 6 successfully treated patients at median 11 months (range, 2-101 months) showed no local tumor progression. In 2 patients with solitary kidneys, estimated glomerular filtration rate declined from 63 mL/min/1.73 m² to 45 mL/min/1.73 m² and 67 mL/min/1.73 m² to 40 mL/min/1.73 m² at 101 months and 12 months following treatment, respectively. Estimated glomerular filtration rate remained > 60 mL/min/1.73 m² in the remaining patients.

In this small select group of patients, percutaneous cryoablation afforded a safe and, based on early outcomes, effective means of providing local control of locally invasive RCC. Percutaneous cryoablation may obviate the need for nephrectomy in similar patients.