SIR 2024
Interventional Oncology
Christopher Gallo, MD (he/him/his)
Resident
Duke University
Financial relationships: Full list of relationships is listed on the CME information page.
James Ronald, MD, PhD
Associate Professor of Radiology
Duke University Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
Brendan Cline, MD
Assistant Professor of Radiology
Duke University Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
Jon G. Martin, MD (he/him/his)
Assistant Professor of Radiology
Duke University Medical Center
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Alan Alper Sag, MD
Assistant Professor, Interventional Radiology and Orthopaedic Surgery
Duke University Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
Nicholas T. Befera, MD
Assistant Professor
Duke University Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
Charles Y. Kim, MD, FSIR
Professor and Chief of Interventional Radiology
Duke University
Financial relationships: Full list of relationships is listed on the CME information page.
The cryoprobe-assisted renal displacement technique entails manual repositioning of the kidney and target lesion away from an adjacent critical structure by exerting force on a cryoprobe that is frozen within the kidney. Only sparse case reports are reported in the literature. The purpose of this study was to evaluate the technical success, safety, and outcomes of cryoprobe-assisted renal displacement as a technique to protect surrounding structures during renal cryoablation in a cohort of patients.
Materials and Methods:
This retrospective study was comprised of 21 consecutive patients (9 males, mean age 68 yrs) who underwent CT-guided cryoablation using cryoprobe-assisted renal displacement to avoid nontarget ablation. Traction (n=16), torque (n=2), translation (n=1), or a combination of forces (n=2) was manually applied to indwelling cryoprobes to protect adjacent colon (n=11), duodenum (n=6), ureter (n=2), or retroperitoneal nerves (n=2). Cryoprobe-assisted renal displacement was employed as the first-line protective technique (n=5) or in the setting of inadequate (n=9) or infeasible (n=7) hydrodissection. Technical success was defined as the ability to adequately displace the target lesion from adjacent critical structures to perform cryoablation. Local recurrence-free survival was estimated using the Kaplan Meier technique.
Results:
The median tumor size was 2.5cm (range 1.2-4cm). Technical success in renal displacement was achieved in 19/21 (90%) patients. Median length of target lesion displacement from the adjacent critical structure of interest was 1.0cm (range 0.4-3.4 cm). The amount of perinephric fat did not correlate with technical success. No cryoprobe damage or malfunction resulted from this technique. No complications resulting from nontarget ablation occurred. No iceball fractures were identified. The single moderate adverse event involved the development of a perinephric fluid collection after thawing and removal of cryoprobes, presumed blood and urine, which was self-limited and required no treatment or escalation in care. For patients in whom at least three months of imaging follow up was available (15/21; 75%), local recurrence-free survival was 100% at 1 and 2 years.
Conclusion:
Cryoprobe-assisted renal displacement is a feasible and safe technique to protect critical adjacent structures during renal cell carcinoma cryoablation with high technical success rates as a primary or secondary method to avoid nontarget ablation.