Percutaneous hydrodissection for thermoprotection during cryoablation of periureteric and pyeloureteric junction renal c
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INTERVENTIONAL RADIOLOGY
Percutaneous hydrodissection for thermoprotection during cryoablation of periureteric and pyeloureteric junction renal cell carcinomas Julia Weiss1 · Julien Garnon1 · Roberto Luigi Cazzato1 · Pierre Auloge1 · Jean Caudrelier1 · Danoob Dalili2 · Emanuele Boatta1 · Pierre De Marini1 · Guillaume Koch1 · Afshin Gangi1 Received: 9 May 2020 / Revised: 27 August 2020 / Accepted: 3 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Objective To report our experience of percutaneous image-guided cryoablation of renal tumors located within 10 mm of the pyeloureteric junction (PUJ) and/or ureter, with hydrodissection as a stand-alone thermoprotective technique. Materials and methods All patients who were offered combined hydrodissection and cryoablation of the PUJ/ureter to treat stage-1 renal cell carcinoma were retrospectively reviewed. Data regarding patients, lesions, and outcomes were collected. Results Twenty tumors in 20 patients (13 males:7 females) with a mean age of 74.4 ± 7.5 were included. Mean tumor size was 27.6 ± 6.4 mm. Nearby vulnerable structure(s) were identified as the ureter in 5/20 cases, the PUJ in 8/20 cases and both the PUJ and the ureter in the remaining 7/20 cases (35%) cases. Mean minimal distance between the tumor and the vulnerable organ(s) was 4.8 ± 2.6 mm (range 0–10). A mean of 1.7 ± 0.6 spinal needles were used per intervention with a mean time to complete hydrodissection of 18.6 ± 13.4 min. Primary and secondary technical efficacy rates were 90% and 95%, respectively. Mean follow-up was 23.1 ± 9.2 months. There were no immediate or delayed complications, in particular no urothelial strictures. Two tumor recurrences occurred during follow-up, with a time to disease progression of 13 and 31 months, respectively. Conclusion hydrodissection of the PUJ/ureter to prevent thermal injury during cryoablation is an effective technique and does not seem to compromise the efficacy of ablation at short or mid-term follow-up. Keywords iMRI · CT · Intervention · Cryoablation · Thermoprotection
* Julia Weiss [email protected]
Pierre De Marini [email protected]
Julien Garnon [email protected]
Guillaume Koch [email protected]
Roberto Luigi Cazzato [email protected]
Afshin Gangi afshin.gangi@chru‑strasbourg.fr
Pierre Auloge [email protected]
1
Jean Caudrelier [email protected]
Department of Interventional Radiology, Nouvel Hôpital Civil, 1, Place de l’Hôpital, 67096 Strasbourg Cedex, France
2
School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
Danoob Dalili [email protected] Emanuele Boatta emanuele.boatta@chru‑strasbourg.fr
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Vol.:(0123456789)
Abdominal Radiology
Introduction
Study population and lesions
Percutaneous cryoablation is an effective curative treatment for stage-1 renal cell carcinoma, with oncological results challenging those of surgery for tumors measuring less 4 cm [1–4]. The safety of the technique is also e
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