Ablation of small renal masses Flashcards
Renal cell carcinoma (RCC) accounts for__% of all cancers.
Renal cell carcinoma (RCC) accounts for 2-3% of all cancers.
This increasing incidence is more prominent in young (less than 40 years old) and (AGE). Most of these incidental renal tumours detected on imaging are in the (STAGE)
This increasing incidence is more prominent in young (less than 40 years old) and elderly patients (between 60-79 years old). Most of these incidental renal tumours detected on imaging are in the early or T1 stage
After consideration of the benign or malignant nature and the aggressiveness of the cT1a renal tumours, there are three possible approaches one can adopt when an incidental small RCC is detected on imaging:
(3)
After consideration of the benign or malignant nature and the aggressiveness of the cT1a renal tumours, there are three possible approaches one can adopt when an incidental small RCC is detected on imaging:
nephron-sparing surgery (NSS)
thermal ablation (TA)
active surveillance (AS).
Focal therapies for treatment of SRMs - incidence of thermal ablation techniques
AUA surveys show that the utilisation of thermal ablation:
is higher in an ___
increases at ___ [6, 8].
Focal therapies for treatment of SRMs - incidence of thermal ablation techniques
AUA surveys show that the utilisation of thermal ablation:
is higher in an academic environment
increases at high volume medical centres [6, 8].
Patient characteristics, including (3 factors) drive the selection between surgery and focal therapies when active treatment is indicated.
Patient characteristics, including comorbidity, life expectancy, tumour characteristics (size and anatomic tumour relations) drive the selection between surgery and focal therapies when active treatment is indicated.
The currently accepted indications for renal mass cryoablation are:
cT1a tumour (SRM)
being elderly
high comorbidity load
CKD (moderate or severe)
solitary kidney
Familial RCC syndrome
the patient’s wish to have treatment.
Two consecutive cycles of ___ are recommended to increase the degree of cellular damage and amount of tissue lethally treated
Two consecutive cycles of freeze-thaw are recommended to increase the degree of cellular damage and amount of tissue lethally treated
Procedural details
The following should be remembered when cryoablation of renal tumours is indicated:
(6)
Procedural details
The following should be remembered when cryoablation of renal tumours is indicated:
two consecutive freeze-thaw cycles must be completed
the use of multiple thin cryoprobes is preferable
ice ball should extend 0.5cm beyond tumour edges
LCA may be indicated in anterior renal masses when bowel displacement is unsuccessful, where the tumour is in contact with the ureter or in upper pole tumours
intracavity US should be used when undertaking LCA to control cryoprobe placement
PCA is the preferable choice for endophytic tumours.
Percutaneous cryoablation (PCA) - advantages and disadvantages
Advantages
__
Disadvantages
A disadvantage is that ___will be needed in 20-50% of the cases
___t of the cryoprobes can be used in order to reduce the radiation dose.
Percutaneous cryoablation (PCA) - advantages and disadvantages
Advantages
An advantage of PCA is that it can be performed under conscious sedation in up to 84% of the cases [20], which entails a shorter hospital stay
Disadvantages
A disadvantage is that bowel displacement (hydro or gas) will be needed in 20-50% of the cases
Ultrasound placement of the cryoprobes can be used in order to reduce the radiation dose.
About 80% of complications in LCA are ___
Subtotal treatment has been described in up to __ of procedures.
The absence of recurrence or oncological efficacy is defined as a ___
When PCA is performed a contrast CT control usually takes place at the end or ___
About 80% of complications in LCA are Clavien-Dindo grade I-II or minor.
Subtotal treatment has been described in up to 8% of procedures.
The absence of recurrence or oncological efficacy is defined as a persistent lack of radiological contrast enhancement.
When PCA is performed a contrast CT control usually takes place at the end or 24 hours after ablation.
