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Radiofrequency ablation of small renal cortical tumours in healthy adults: renal function preservation and intermediate oncological outcome
Author(s) -
Stern Joshua M.,
Gupta Amit,
Raman Jay D.,
Cost Nicholas,
Lucas Steven,
Lotan Yair,
Raj Ganesh V.,
Cadeddu Jeffrey A.
Publication year - 2009
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2009.08443.x
Subject(s) - medicine , nephrectomy , renal function , renal cell carcinoma , biopsy , radiofrequency ablation , radiology , kidney disease , urology , radiological weapon , kidney , surgery , ablation
OBJECTIVES To present the glomerular filtration rate (GFR) and oncological outcomes in a series of patients with cT1a renal cortical tumours treated with radiofrequency ablation (RFA), a non‐ischaemic minimally invasive ablative method, as nephron‐sparing surgery gives excellent oncological outcomes and preserves renal function. PATIENTS AND METHODS Healthy (American Society of Anesthesiologists, ASA, I and II) patients with cT1a renal masses were identified, and clinical and radiographic data were reviewed to assess indications, complications, radiological evidence of disease recurrence, and renal function. Changes in GFR were calculated. Radiological recurrence was defined as any new enhancement (>10 Hounsfield units) after absence of enhancement on initial 6‐week computed tomography. RESULTS Four patients were ASA I and 59 were ASA II; the median (range) age was 58 (20–84.6) years and the lesion diameter 2.1 (1–4.0) cm. Preoperative needle biopsy was diagnostic in 89% of patients, including 75% diagnostic of renal cell carcinoma (RCC). At a median (range) follow‐up of 34 (1.0–80) months the renal preservation rate was 97%. One patient had a nephrectomy for biopsy‐confirmed recurrence of RCC at 55 months; a second had a nephrectomy at 24 months for suspected radiographic recurrence, but had no evidence of disease on final pathology. A fifth (20%) of the patients had chronic kidney disease at the time of diagnosis. The median GFR before and after RFA was 76.3 and 74.3 mL/min/m 2 (difference 2.0 mL/min/m 2 ). CONCLUSION RFA might be a reasonable treatment choice for the healthy patient, with appropriate informed consent. Intermediate results suggest excellent oncological outcomes and preservation of renal function.