Role of Cryoablation for the Treatment of cT1b Kidney Lesions: Outcomes of a Systematic Review
Abstract
Introduction The American Urological Association (AUA) and the European Association of Urology (EAU)
currently recommend partial nephrectomy (PN) over ablation for cT1b lesions. However, recent series have shown
comparable outcomes for cryoablation (CA) when compared to PN, making it an appealing alternative for a select
group of patients. The objective of this manuscript is to assess treatment outcomes and complications of CA for cT1b
lesions.
Methods Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a
comprehensive search was done on MEDLINE and Cochrane Library electronic databases identifying studies that
reported on outcomes and complications of CA for kidney tumors. Inclusion criteria included cT1b lesions between 4
cm and 7 cm, excluding treatment of other sizes.
Results A total of 347 patients with cT1b lesions identified on imaging underwent percutaneous or laparoscopic
CA. The average age was > 65 years, the median size of lesions and RENAL score ranged between 4.3–4.8 cm and
8–9, respectively. The majority of patients had a Charlson comorbidity index (CCI) of 2, and median follow-up
ranged between 13 months and 95 months. Across all the series, primary and secondary success rates were between
84%–98% and 92%–98%, respectively. The local recurrence ranged from 2.8% to 27%. For patients with documented
RCC on biopsy, the 5-year overall survival (OS), cancer-specific survival (CSS), recurrence-free survival (RFS), and
metastasis-free survival (MFS) ranged from 56%–91%, 85%–100%, 70%–96.4%, and 90%–96%, respectively. The
major complication rate (Clavien-Dindo III-V) was low, at 6.2%.
Conclusion With promising survival outcomes and low complication rates perioperatively, CA is acceptable in a
select group of patients with T1b renal tumors, including those who are older, have multiple comorbidities, or have
relative or absolute contraindication to surgery.
The Société International d'Urologie (SIU), which owns and publishes the Société International d'Urologie Journal (SIUJ), does not require authors of papers published in the journal to transfer copyright. Instead, we ask authors to grant an exclusive licence that allows us to publish the article in SIUJ (and any derivative or related products or publications) and that allows us to sub-license such rights and exploit all subsidiary rights.
Authors retain the right to use their own articles for their own non-commercial purposes without seeking explicit permission from SIU.
The SIUJ publication licence expressly defines “non-commercial” as “not primarily intended for or directed towards commercial advantage or monetary compensation.” Although no activity is completely disconnected from commercial activity, the following are generally considered to be non-commercial uses:
- Reproduction of a reasonable number (no more than 100) of print copies of the published paper for personal use (e.g., sharing with colleagues, including in grant applications).
- Posting a copy of the published version of the paper on the author’s own or their institution’s website. The article must be accompanied by this statement: ‘This article has been published in the SIUJ: [full citation; link]’.
- Inclusion of the paper in a course pack, with a maximum of 100 copies to be used in the author’s institution. The copies must include the following acknowledgement: ‘This article has been published in the SIUJ: [full citation; link].’
As the distinction between commercial and non-commercial is not always clear, authors are strongly advised to seek permission from SIU for any use that may be considered to have a commercial aspect.
We ask the corresponding author to read the terms of the licence and then to grant this exclusive licence on behalf of all authors by indicating agreement to the following statement:
The corresponding author has the right to grant on behalf of all authors and does grant on behalf of all authors, an exclusive licence on a worldwide basis to the SIU and its licensees to permit this article (if accepted) to be published in the SIUJ and any other SIU products and publications and to exploit all subsidiary rights, as set out in our licence agreement.
Review and Decision
Most submissions will be reviewed by a senior editor within 2 weeks. Many manuscripts will be rejected at this point for a variety of reasons, including subject matter outside the scope of the SIUJ, flawed design, discredited or outdated methodology, poor organization or presentation, failure to conform to ethical requirements, and apparent plagiarism.The remaining manuscripts will be sent for peer review. The SIUJ uses a single-blind process: reviewers know the identity of the authors, but the authors are not told who has reviewed their manuscript, and SIUJ ensures that potentially identifying information is removed from comments sent to them. Reviewers are asked to make their recommendations within 10 days, after which a senior/specialist editor will consider their comments and recommend provisional acceptance dependent on satisfactory revision, acceptance without revision, or rejection. Authors should receive a final decision within 4 to 6 weeks of submission.
