Percutaneous Cryoablation of Renal Tumors: Initial Indian Experience

Objective The purpose of this study was to report short-term outcomes of cryoablation of early-stage renal tumors (T1a and T1b) at a tertiary hospital in India. Methods This was a retrospective study of consecutive patients who underwent cryoablation for renal cell carcinoma (RCC) from November 2018 to June 2020. Cryoablation was performed under combined ultrasound and computed tomography guidance using a helium-argon cryoablation system. Tumor number, size, location, nephrometry score, relationship of the tumor with pelvicalyceal system, and adjacent organs were tabulated, and technical and clinical success evaluated. Early and late recurrence and complications were also assessed. Results Eleven patients (median age: 62 years) with 11 tumors underwent cryoablation. The mean tumor size was 2.58 cm (range: 1.62–5.62 cm) with 10 lesions being T1a and one lesion T1b. Tissue sampling was done in 9/11 patients, 3 were papillary RCC and the rest, clear cell RCC. In two patients, the tumor was completely endophytic, three patients had partially endophytic tumors while 6 patients had exophytic lesions. The median nephrometry score was 6 (range: 4–11, Mode 4). Technical success was achieved in all patients. Complete response was achieved in 81% (9/11) of the patients at 1-month follow-up. Median follow-up period was 6 months. Two patients showed residual disease on follow-up imaging at 1 and 3 months, respectively. Conclusion Cryoablation is a promising, relatively new minimally invasive therapy for treating small renal tumors in India. It is safe, technically feasible, and shows excellent short-term efficacy.

Imaging Tool for Predicting Renal Clear Cell Carcinoma Fuhrman Grade: Comparing R.E.N.A.L. Nephrometry Score and CT Texture Analysis

Background. Clear cell renal cell carcinoma (ccRCC) is the most common renal malignant tumor. Preoperative imaging boasts advantages in diagnosing and choosing treatment methods for ccRCC. Purpose. This study is aimed at building models based on R.E.N.A.L. nephrometry score (RNS) and CT texture analysis (CTTA) to estimate the Fuhrman grade of ccRCC and comparing the advantages and disadvantages of the two models. Materials and Methods. 143 patients with pathologically confirmed ccRCC were enrolled. All patients were stratified into Fuhrman low-grade and high-grade groups with complete CT data and R.E.N.A.L. nephrometry scores. CTTA features were extracted from the ROI delineated at the largest tumor level, and RNS and CTTA features were included in the logistic regression model, respectively. Results. RNS model constructed based on multivariate logistic regression analysis showed that 3 pts for R -scores, 2 pts for E -scores, and 3 pts for L -scores were significant indicators to predict high-grade ccRCC, the AUC of RNS model was 0.911, and the sensitivity and specificity were 71.11% and 83.67%, respectively. The CTTA-model confirmed energy, kurtosis, and entropy as independent predictive factors, and the AUC of CTTA model was 0.941, with an optimal sensitivity and specificity of 84.44% and 93.88%. Conclusions. R.E.N.A.L. nephrometry score has a certain provocative effect on the Fuhrman pathological grading of ccRCC. As a potential emerging technology, CTTA is expected to replace R.E.N.A.L. nephrometry score in evaluating patients’ Fuhrman classification, and this approach might become an available method for assisting clinicians in choosing appropriate operation.

The Application of R.E.N.A.L. Nephrometry Score In Laparoscopic Partial Nephrectomy With Zero Ischemia And Sutureless

Background: To evaluate the application of R.E.N.A.L. nephrometry score (RNS) in laparoscopic partial nephrectomy (LPN) with zero ischemia and sutureless surgery, and to explore the efficacy and safety of zero ischemia and seamless LPN in the treatment of renal cell carcinoma.Methods: The clinical data of 67 patients with renal cell carcinoma treated by LPN in the affiliated Hospital of Guizhou Medical University from January 2016 to July 2020 were analyzed retrospectively. The patients were divided into renal artery occlusion group (n=31) and non-occlusion group (n=36). All cases were divided according to their RNS (low, moderate, and high), and the perioperative condition, postoperative complications, postoperative recovery and changes of renal function in the two groups were analyzed.Results: According to the RNS, all cases were classified in low-complex. Both groups successfully completed the operation without operative complications. Compared with the renal artery occlusion group, the non-occlusion group had a shorter operation time (35.51±20.48 min), shorter hospital stay (6.72±4.39 d), and no significant difference in intraoperative blood loss(50.39±30.19 ml). During the 6-month follow-up, the creatinine value of the renal function in the non-occlusion group (78.47±10.98μmol/L) was lower than that in the occlusion group(98.21±8.06μmol/L).Conclusion: Zero-ischemia sutureless LPN technique can effectively reduce the time of ischemia and avoid renal ischemia-reperfusion injury. This surgical technique may be a feasible surgical method for the treatment of low RNS renal cell carcinoma.

Nephrometric score based on 3D modeling (3D nephrometry score) for the probability prediction of intra- and postoperative complications for kidney surgery

Aim: The purpose of the study is the development and evaluation of the informativeness of the author’s 3D nephrometric score application to predict the probability of intraoperative and postoperative complications in kidney operations. Material and methods: The study includes 264 patients who underwent surgical treatment of renal tumors, before that CT and 3D modeling were carried out. All patients underwent an analysis of the surgical intervention complexity on the C-index, PADUA, R.E.N.A.L., and developed 3D nephrometric score. To determine the set of variables that allow to classify patients, the method of discriminant analysis was used to predict the nature, volume of blood loss, duration of ischemia, and the number of complications. The sensitivity and specificity of the predictors were estimated with the help of ROC analysis. Results: Indicators have been established to classify patients according to the probability of complications, the amount of blood loss and the duration of ischemia during surgery for kidney cancer. We have created linear models that predict the development of bleeding during surgery, the volume of blood loss of more than 200 ml and the duration of ischemia more than 20 min, as well as the likelihood of complications using discriminant functions. The proposed author’s nephrometric score exceeds the capabilities of C-index, PADUA, R.E.N.A.L in many ways in blood loss and time of ischemia predicting, which allows us to recommend it for the assessment of resectability in kidney operations.