Mp51-06 Renal Mass Ablation in Severely Comorbid Patients With T1a Renal Cell Carcinoma

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging/Surveillance II (MP51)1 May 2024MP51-06 RENAL MASS ABLATION IN SEVERELY COMORBID PATIENTS WITH T1A RENAL CELL CARCINOMA Kamil Malshy, Emily Barry, Borivoj Golijanin, Scott Collins, Yuanqing Bao, Aaron Maxwell, Gregory Dubel, Anthony Mega, Sari Khaleel, Nathaniel Rex, Bryan Jay, and Dragan Golijanin Kamil MalshyKamil Malshy , Emily BarryEmily Barry , Borivoj GolijaninBorivoj Golijanin , Scott CollinsScott Collins , Yuanqing BaoYuanqing Bao , Aaron MaxwellAaron Maxwell , Gregory DubelGregory Dubel , Anthony MegaAnthony Mega , Sari KhaleelSari Khaleel , Nathaniel RexNathaniel Rex , Bryan JayBryan Jay , and Dragan GolijaninDragan Golijanin View All Author Informationhttps://doi.org/10.1097/01.JU.0001009492.49624.4b.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: This study examines the cost effectiveness of T1a renal mass ablation (RMA) in severely comorbid patients. METHODS: We retrospectively reviewed records of patients who underwent RMA for T1a lesions at our tertiary center From 1/2018- 7/2023. We included patients with severe Charlson Comorbidity Index (CCI) defined as ≥6 (expected 10-year overall survival of <2%, Charlson, 1987). Clinicodemographic data were collected. The cost of treatment included imaging (both perioperatively and per follow-up protocols), RMA, lesion biopsy, and management of postoperative complications. Self-pay prices of procedures were obtained from the hospital. RESULTS: 333 RMAs were performed during the study period. 146 patients (90 [61.7%] males and 56 [38.3%] females) met the inclusion criteria with a median CCI of 7 (IQR 6-8) and a renal mass size of 2.5 cm (1.9-2.9). The median age was 75.1 (70-81.5). 108 patients (68.4%) were considered poor surgical candidates, 41 (26%) chose to have RMA and 9 (5.7%) team preference. Diagnoses was incidental in 84.3% of the cases (n=123). 138 (94.5%) had microwave ablation and 8 (5.5%) cryoablation. 136 (39.2%) were treated as outpatients and 6 (4.6%) required general anesthesia. 133 (91%) had tumor biopsy with 123 (84.3%) with RMA simultaneously; 74 (60.1%) were diagnosed with RCC. 5 (3.4%) experienced Clavien-Dindo Grade 3a complications within 90 days (3 had bleeding requiring angioembolization, 2 had ureteral obstruction requiring nephrostomy insertion - 1 had both), higher grade complications were not reported. After a median follow-up of 2.2 (1-4) years, 10 (6.8%) had local tumor recurrence. 5 had repeat RMA and 1 required radical nephrectomy. In addition, 2 had progressed to metastatic disease. During the above mentioned follow up period, 20 (13.7%) died for different reasons, while none of them died from cancer-specific causes, with overall mortality at 13.7% and cancer-specific mortality at 0%. Overall, the cohort's treatment cost was 4.51M$ with an average cost of 31K$ per procedure. Table 1 details treatment costs. CONCLUSIONS: High percentage of severely comorbid patients had RMA in our study. Despite high costs, several complications, and demanding follow-up, cancer specific mortality was negligible compared with overall mortality. In this patient population, watchful waiting may be preferred. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e843 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Kamil Malshy More articles by this author Emily Barry More articles by this author Borivoj Golijanin More articles by this author Scott Collins More articles by this author Yuanqing Bao More articles by this author Aaron Maxwell More articles by this author Gregory Dubel More articles by this author Anthony Mega More articles by this author Sari Khaleel More articles by this author Nathaniel Rex More articles by this author Bryan Jay More articles by this author Dragan Golijanin More articles by this author Expand All Advertisement PDF downloadLoading ...