Pleural Complications in Patients with Renal Cell Carcinoma Undergoing Percutaneous Cryoablation: A Retrospective Analysis of its Incidence and Risk Factors

Ibrahim Khatim; Isam Albaba; Marc A Judson; Kurt Hu; Sana Ali; Harpreet Singh; Khezar Syed; Moses Koo; Timothy Yung; Paul Feustel; Ramkrishna Patel; Gary Siskin; Amit Chopra

doi:10.1016/j.amjms.2024.09.003

Pleural Complications in Patients with Renal Cell Carcinoma Undergoing Percutaneous Cryoablation: A Retrospective Analysis of its Incidence and Risk Factors

Am J Med Sci. 2024 Sep 16:S0002-9629(24)01447-2. doi: 10.1016/j.amjms.2024.09.003. Online ahead of print.

Authors

Ibrahim Khatim¹, Isam Albaba², Marc A Judson³, Kurt Hu⁴, Sana Ali³, Harpreet Singh⁴, Khezar Syed⁴, Moses Koo⁴, Timothy Yung⁵, Paul Feustel⁶, Ramkrishna Patel⁷, Gary Siskin⁷, Amit Chopra⁸

Affiliations

¹ Department of Internal Medicine, Albany Medical Center, Albany, NY, USA.
² Division of Pulmonary and Critical Care Medicine, Temple University, Philadelphia, PA.
³ Division of Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY, USA.
⁴ Department of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
⁵ Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
⁶ Departments of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA.
⁷ Department of Radiology, Albany Medical Center, Albany, NY, USA.
⁸ Division of Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY, USA. Electronic address: chopraa1@amc.edu.

PMID: 39293739
DOI: 10.1016/j.amjms.2024.09.003

Abstract

Rationale: Observations from our clinical practice indicate a notable occurrence of pleural complications post-percutaneous renal cryoablation (PRC).

Objective: To identify the incidence of pleural complications following PRC and potential risk factors associated with post-procedural pleural complications.

Materials and methods: This was a retrospective cohort analysis of patients undergoing PRC at two tertiary hospital systems between 2016 and 2022. Patient characteristics, radiological and clinical data, and procedure techniques were collected in a database to identify potential risk factors.

Results: A total of 285 patients were identified who underwent 312 PRC procedures during the specified inclusion period. Among these, 10 procedures (3.2%) led to pleural complications, all manifesting as pleural effusions. Of these complications, 3 patients (1%) required pleural drainage. Factors associated with an increased risk of pleural complications included a larger mean tumor size (4.3 cm vs 2.7 cm, P = <0.001), cryoprobe applicator entry at the T10-T11 level as opposed to lower sites (P = 0.029), and a higher median number of cryoprobe applicators employed (3.5 vs 2.0, P = 0.001). Moreover, individuals who experienced pleural complications had a longer median hospital stay (4.0 vs 0, P≤0.001) and a higher rate of blood transfusions (40% vs 0.7%, P≤0.001).

Conclusion: Pleural complications from percutaneous renal cryoablation are rare. To further reduce the risk, higher insertion points (above T12) and utilizing more than two cryoprobe applicators should be avoided when feasible. Pleural complications in patients with new respiratory symptoms after PRC should be considered.

Keywords: Percutaneous Cryoablation; Pleural Complication; Pleural Effusion; Pneumothorax; Renal Cell Carcinoma.