TY - JOUR AU - El-Achkar, Adnan AU - Khader, Mustafa AU - Farkouh, Ala'a AU - Hassanieh, Joelle AU - Somani, Bhaskar AU - Shahait, Mohammed PY - 2023/05/16 Y2 - 2024/03/30 TI - Role of Cryoablation for the Treatment of cT1b Kidney Lesions: Outcomes of a Systematic Review JF - Société Internationale d'Urologie Journal JA - Soc Int Urol J VL - 4 IS - 3 SE - Review/Meta-Analysis DO - 10.48083/IMBM6087 UR - https://siuj.org/index.php/siuj/article/view/267 SP - 211-222 AB - 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 showncomparable outcomes for cryoablation (CA) when compared to PN, making it an appealing alternative for a selectgroup of patients. The objective of this manuscript is to assess treatment outcomes and complications of CA for cT1blesions.Methods Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, acomprehensive search was done on MEDLINE and Cochrane Library electronic databases identifying studies thatreported on outcomes and complications of CA for kidney tumors. Inclusion criteria included cT1b lesions between 4cm and 7 cm, excluding treatment of other sizes.Results A total of 347 patients with cT1b lesions identified on imaging underwent percutaneous or laparoscopicCA. The average age was > 65 years, the median size of lesions and RENAL score ranged between 4.3–4.8 cm and8–9, respectively. The majority of patients had a Charlson comorbidity index (CCI) of 2, and median follow-upranged between 13 months and 95 months. Across all the series, primary and secondary success rates were between84%–98% and 92%–98%, respectively. The local recurrence ranged from 2.8% to 27%. For patients with documentedRCC on biopsy, the 5-year overall survival (OS), cancer-specific survival (CSS), recurrence-free survival (RFS), andmetastasis-free survival (MFS) ranged from 56%–91%, 85%–100%, 70%–96.4%, and 90%–96%, respectively. Themajor 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 aselect group of patients with T1b renal tumors, including those who are older, have multiple comorbidities, or haverelative or absolute contraindication to surgery. ER -