Gangrene of the Kidney Following Percutaneous Renal Cryoablation of a Small Tumor.

Background: In selected cases cryoablation is a valid treatment option for small renal masses. The procedure is generally considered oncologically efficient with a low rate of severe complications. We report here a case of a 62-year-old man who after percutaneous cryoablation develops severe gangrene in the treated kidney. Case Presentation: A 62-year-old man was incidentally diagnosed with a 45-mm renal cell carcinoma. The tumor was found on a CT scan performed on the suspicion of diverticulitis. An abscess in relation to the sigmoid was found and he was treated with aspiration and antibiotics. The tumor was treated with percutaneous cryoablation 20 days later. On the third postoperative day, he was readmitted with urosepsis. A CT scan revealed gangrene at the ablation site, and a nephrectomy was performed. Clinical progress was slow, and a new CT scan showed reformation of the abscess at the sigmoid and a suspicion of a colonic tumor was raised. This was confirmed by coloscopy and biopsy. The patient had a right hemicolectomy, and the pathology report described a T4 adenocarcinoma with positive margins. After 4 months follow-up, metastases to the lungs was found and the patient was referred to further oncologic treatment. Conclusion: Renal cryoablation is generally a very safe procedure, but severe complications may occur. This case report highlights that attention should be given to recent abdominal infections and that delayed intervention might be in place in selected cases.

Renal cryoablation: five- and 10-year survival outcomes in patients with biopsy-proven renal cell carcinoma.

OBJECTIVE: To investigate the long-term oncological efficacy of renal cryoablation (CA) of small renal tumors. MATERIALS AND METHODS: A review of patients treated with CA for a biopsy confirmed renal cell carcinoma less than 4 cm in diameter. All patients were identified from a prospectively maintained clinical database. Treatment efficacy was computed using the Kaplan-Meier method to estimate disease-free survival (DFS) and overall survival rates (OS). RESULTS: A total of 179 patients (116 men and 63 women) with a mean age of 64 years (95% CI = 63 - 66) were included in the analysis. Mean tumor size was 27 mm (95% CI = 25.5-28.0) with a low, moderate and high PADUA complexity score in 30.2%, 44.7% and 16.2% of the cases, respectively. A total of 19 patients (11%) were diagnosed with residual unablated tumor, six patients (3%) were diagnosed with late local recurrence and six patients (3%) were diagnosed with metastatic disease. The estimated 5 years image confirmed the DFS rate was 79% (95% CI = 70-85). The estimated 5- and 10-year OS rates were 82% (95% CI = 75-87) and 61% (95% CI = 48-71), respectively. During the 10-year follow-up period a total of five patients (3%) died due to renal cancer, while 46 patients (26%) died from other causes. CONCLUSIONS: CA appears to be an effective treatment modality for patients with small renal tumors. The present study demonstrated low rates of local recurrence and disease progression with excellent long-term cancer-specific survival.

Migration of clips to the colon after laparoscopic partial nephrectomy.

A 78-year-old man was treated with laparoscopic partial nephrectomy for a 4 cm tumour in the lower pole of the left kidney. The patient was discharged 2 days postoperatively. Preoperatively there was no sign of metastasis; the pathology indicated complete removal of the tumour, a renal cell carcinoma. 53 days postoperatively the patient had acute onset of rectal bleeding. A colonoscopy revealed necrosis and three clips on the wall of the colon corresponding to where the descending colon passes over the left kidney. The patient was treated conservatively. Clip migration has been reported previously, but to our knowledge we present the first case of clip migration to the colon after laparoscopic partial nephrectomy. Suggestions to avoid the presented complication are made.