Irreversible Electroporation for the Treatment of Small Renal Masses: 5-Year Outcomes

Jessica C. Dai, Tara N. Morgan, Ryan L. Steinberg, Brett A. Johnson, Alaina Garbens, Jeffrey A. Cadeddu

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations

Abstract

Introduction: Irreversible electroporation (IRE) is a nonthermal ablative technology that applies high-voltage short-pulse electrical current to create cellular membrane nanopores and ultimately results in apoptosis. This is thought to overcome thermal limitations of other ablative technologies. We report 5-year oncologic outcomes of percutaneous IRE for small renal masses. Patients and Methods: A single-institution retrospective review of cT1a renal masses treated with IRE from April 2013 to December 2019 was performed. Those with <1 month follow-up were excluded. IRE was performed with the NanoKnife System (Angiodynamics, Latham, NY). Renal mass biopsy was obtained before or during ablation in most circumstances; biopsy was excluded in some patients because of concern for IRE probe displacement. Postablation guideline-based surveillance imaging was performed. Initial treatment failure was defined as persistent tumor enhancement on first post-treatment imaging. Survival analysis was performed through the Kaplan-Meier method for effectively treated tumors (SPSS; IBM, Armonk, NY). Results: IRE was used to treat 48 tumors in 47 patients. Twenty-two per 48 tumors (45.8%) were biopsy-confirmed renal cell carcinoma (RCC). No complications ≥ Clavien Grade III occurred and 36 patients (76.6%) were discharged the same day. Initial treatment success rate was 91.7% (n = 44/48); three treatment failures were managed with salvage radiofrequency ablation and one with robotic partial nephrectomy. Median follow-up was 50.4 months (interquartile range 29.0-65.5). The 5-year local recurrence-free survival was 81.4% in biopsy-confirmed RCC patients and 81.0% in all patients. Five-year metastasis-free survival was 93.3% and 97.1%, respectively, and 5-year overall survival was 92.3% and 90.6%, respectively. Five-year cancer-specific survival was 100% for both biopsy-confirmed RCC and all patient groups. Conclusions: IRE has low morbidity, but suboptimal intermediate-term oncologic outcomes compared with conventional thermal ablation techniques for small low-complexity tumors. Use of IRE should be restricted to select cases.

Original languageEnglish (US)
Pages (from-to)1586-1592
Number of pages7
JournalJournal of endourology
Volume35
Issue number11
DOIs
StatePublished - Nov 2021

Keywords

  • Ablation
  • Irreversible electroporation
  • Recurrence
  • Renal cell carcinoma
  • Small renal mass

ASJC Scopus subject areas

  • Urology

Fingerprint

Dive into the research topics of 'Irreversible Electroporation for the Treatment of Small Renal Masses: 5-Year Outcomes'. Together they form a unique fingerprint.

Cite this