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Masses Treated by Thermal Ablation are Low or Moderately Complex as Measured by the R.E.N.A.L-Nephrometry Scoring System
Jose Reyes, Daniel Canter, Jay Simhan, Marc Smaldone, Ervin Teper, Alexander Kutikov, Rosalia Viterbo, David Y.T. Chen, Richard E Greenberg, Robert G Uzzo
Fox Chase Cancer Center, Philadelphia, PA

Despite the AUA Guidelines listing thermal ablation (TA) as a treatment option for the clinical T1 renal mass, treatment decision-making for renal lesions remains subjective. The R.E.N.A.L.-Nephrometry scoring system (NS) was introduced to objectify salient renal mass anatomy and standardize academic reporting. Preliminary reports have evaluated its utility in terms of surgical decision-making and predicting post-operative complications. In this study, we characterize our experience with renal lesions undergoing TA using NS.
Materials & Methods:
We queried our prospectively maintained kidney cancer database of 2,312 patients and identified 39 patients who underwent TA with available Nephrometry scores. Patient clinical, tumor, peri-operative, and oncologic characteristics were reviewed
Median patient age, serum creatinine, estimated glomerular filtration rate, and Charlson Comorbidity Index were 71 (range=57-86) years, 1.39 (range=0.7-3.5) mg/dl, 57.5 (range=23.3-93.8) ml/min, and 2 (range=0-5), respectively. Chronic kidney disease stage III or higher was present in 56% of patients.
Median NS was 6 (4-10). Low (NS=4-6), moderate (NS=7-9), and high (NS=10-12) complexity tumors were observed in 20 (51%), 17 (44%), and 2 (5%) patients. Minor (Clavien I-II) and major (Clavien III-IV) complications occurred in 4 (10%) and 1 (3%) patients, all of whom had moderate complexity tumors. Five (13%) patients had a recurrence, 4 of whom had moderate complexity tumors.

In our institutional experience, 95% of lesions undergoing TA are low or moderate complexity as measured by the R.E.N.A.L-Nephrometry scoring system. There appears to be a direct relationship between increasing tumor complexity and the incidence of peri-procedural complications and disease recurrence.

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