Percutaneous Clinical T1a Renal Mass Ablation in the Octogenarian and Nonagenarian: Oncologic Outcomes and Morbidity.

ABSTRACT

PURPOSE: To evaluate outcomes of percutaneous ablation of small renal tumors in the elderly population. PATIENTS AND METHODS: Using our tumor ablation database, we searched for percutaneous ablation procedures for clinical T1a renal masses in octogenarians and nonagenarians between June 2001 and May 2012. Altogether, 105 tumors from 99 procedures among 95 patients (mean age 84.0±3.0 years, range 80-92) were identified. Oncologic outcomes and major complications were evaluated. Assessment also included patient hospital stays and renal functional outcomes. RESULTS: Technical success was achieved in 60/61 (98.4%) tumors managed with cryoablation and 43/44 (97.7%) after radiofrequency ablation (RFA). Of 87 renal tumors with at least 3 months imaging follow-up, 2 (5.4%) tumors progressed at 1.2 and 2.2 years after RFA. None recurred after cryoablation. Estimated progression-free survival rates at 1, 3, and 5 years after ablation were 99%, 97%, and 97%, respectively. Thirty-four patients died at a mean of 3.7 years after ablation (median 3.7; range 0.4-9.6). Estimated overall survival rates were 98%, 83%, and 61%, respectively. Among 33 patients with sporadic, biopsy-proven renal-cell carcinoma, estimated cancer-specific survival rates were 100%, 100%, and 86%, respectively. Five (8.6%) major complications developed after renal cryoablation with no (0%) major complication after RFA. Mean decrease in serum creatinine level within 1 week after ablation was 0.1 mg/dL. Mean hospitalization was 1.2 days. CONCLUSION: Percutaneous thermal ablation is safe and effective in the active management of clinical T1a renal masses in elderly patients. These results should help urologists appropriately assess expected outcomes when counseling octogenarian and nonagenarian patients.