BERKELEY, CA (UroToday.com) - Despite surgical resection of small renal masses being the treatment of choice and recommended by clinical guidelines, there is a slow but steady increase in percutaneous as well as laparoscopic ablative procedures being offered for management of such tumors. Main reasons for this trend could be sought in promise of a less invasive procedure with reduced blood loss and anesthesia requirements, lower cost, and faster recovery, which may be appealing to patients, and the treating physician as well.
In our abstract we reported a catastrophic case of an elderly patient with advanced age and multiple medical comorbidities who after careful counseling elected to undergo, at our institution, cryoablation of his biopsy-proven cT1a renal cell carcinoma of the left kidney. The patient was a poor surgical candidate and had failed a one-year period of observation during which the mass demonstrated considerable growth. The ablative procedure itself was without event and the patient was discharged home the same day after a brief period of observation.
Upon routine surveillance imaging at 3 months, the mass was not enhancing, but numerous subcutaneous nodules were seen in the probe tract site. An attempt of biopsy to rule out rare but benign inflammatory nodules had to be aborted due to bleeding. However, within a few weeks the diagnosis of local seeding became indisputable with the development additional enhancing retroperitoneal and palpable subcutaneous nodules. In addition, imaging of the chest revealed new pulmonary nodules witnessing widespread metastatic disease.
What can we learn from this case? A review of the literature would suggest that seeding associated with the biopsy and ablation of a solid renal parenchymal mass (unlike, for example, urothelial carcinomas) is a rare event. However, as diagnostic biopsies and ablative therapies become more common, more such complications may occur. Although maneuvers such as the “hot withdrawal” technique (only applicable to radiofrequency ablation) have been described to minimize the chance of tract seeding, the effectiveness of these measures remains unclear. It therefore appears important that patients be informed of the potential risk of seeding prior to consenting to ablative therapy.
Arash Akhavein, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Department of Urology, University of Florida, Gainesville, Florida, USA