Repeated cryoablation as treatment modality after failure of primary renal cryoablation: a European Registry for Renal Cryoablation (EuRECA) multinational analysis.

Objectives: To assess the oncological outcome of recryoablation following failure of primary cryoablation in patients with small renal masses (SRMs). Materials and Methods: A retrospective review of 72 patients with a single renal tumor who failed primary laparoscopy-assisted cryoablation (LCA). All patients were initially treated with LCA at one of three European centers during a 12-year period. Results: A total of 38 patients (53%) were successfully salvaged with reablation(s) following treatment failure after primary LCA, having a median follow-up time of 28 (95% CI 19-105) months. Patients who failed recryoablation with additional cryoablation (n = 11), active surveillance (n = 11), oncological treatment (n = 7), partial nephrectomy/nephrectomy (n = 5), and follow-up terminated according to patient request (n = 4). The disease-free survival was significantly higher for patients retreated with CT-guided cryoablation compared with other cryoablative modalities (57% vs 31%, p = 0.046). Conclusion: Recryoablation following failure of primary cryoablation appears to have a significantly lower success rate compared with what is well known from primary cryoablation of SRM, but does not carry and increase risk of metastatic progression. CT-guided recryoablation appears to be superior to laparoscopy-assisted or ultrasonography recryoablation.