Short- and long-term complications occurred in some patients, but all had a full recovery, study found.


WASHINGTON, D.C.—Most, if not all, complications from CT-guided percutaneous cryoablation for renal cell carcinoma (RCC) are either preventable or reversible, investigators say.

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“In experienced hands, this procedure is safe, and physicians should not shy away from treating even high-risk patients with it,” said Christos Georgiades, MD, PhD, assistant professor of radiology and surgery at Johns Hopkins Hospital in Baltimore.


Although the procedure is being used more and more as an alternative to treat small renal tumors, safety data have been significantly lacking.


Dr. Georgiades and his colleagues characterized the complications associated with the procedure in 65 patients. All patients had baseline history and physical exam, blood work, and renal CT or MRI, and all underwent biopsy at or prior to cryoablation. All patients had an immediate pre-procedure and post-procedure CT. The mean age of the patients was 68 years (range, 52- 88 years).


In all, the physicians used 148 cryoprobes and performed 65 biopsies. The investigators tabulated the type, frequency, and severity of all complications and followed them to resolution or end of study. The researchers defined clinically significant complications as those that resulted in a change in management.


Technical success was achieved in all patients, the researchers reported here at the Society of Interventional Radiology’s 33rd Annual Scientific Meeting. Short-term complications included 12 asymptomatic and eight painful perinephric hematomas, two of which required transfusion. One patient suffered from cryoshock but recovered. Cryoshock is a rare complication (less than 1%) that may occur after ablation. It may precipitate breathing difficulties.


With respect to long-term complications observed over a mean follow-up of 28 weeks, five patients experienced self-limiting hematuria and another five had nerve injuries (four intercostal and one genitofemoral). All had a full recovery. One patient had a significant worsening of renal function, but did not require dialysis and eventually recovered to baseline.


“Considering many of our patients who were too sick or deemed too old to have surgery, this is a surprisingly good outcome,” Dr. Georgiades said.