Percutaneous computed tomography-guided radiofrequency ablation of renal masses in high surgical risk patients: preliminary results.
This article evaluates the safety and efficacy of percutaneous radiofrequency ablation (RFA) delivered by computed tomography (CT) fluoroscopic guidance for the treatment of small, solitary renal lesions in high risk surgical and anesthetic patients. In total, 29 patients with 35 small (</=4 cm) renal lesions underwent a total of 37 CT fluoroscopically guided RFA treatments using a dry RFA technique. Because of medical comorbidities, 26 patients were considered high surgical risk candidates, and 3 patients had von Hippel-Lindau disease. Procedures were performed percutaneously, under intravenous sedation and on an outpatient basis. Renal lesions were monitored on a 3-month basis using precontrast- and postcontrast-enhanced CT imaging to assess for the presence of growth or residual lesion enhancement. Of 37 RFA treatments, 35 (95%) were successfully performed under intravenous sedation and 32 (86%) treatments were performed on an outpatient basis. Over a mean radiographic follow-up period of 9 months, 33 of 35 (94%) renal lesions have required only a single RFA treatment, and 2 patients required a second, successful retreatment for small regions of residual enhancement on follow-up CT imaging. Of 13 renal lesions with a >/=12-month radiographic follow-up interval, 11 (85%) have demonstrated no residual enhancement or growth after RFA. Percutaneous RFA of small, solitary renal lesions is well tolerated in high surgical risk patients. Although early results are encouraging, longer-term follow-up time is necessary to determine the precise role of RFA in this patient population. high resolution video, medium resolution video, low resolution video
Su
L i-Ming
Li
James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. lsu11@jhmi.edu
Jarrett
Thomas W
TW
Chan
David Y
DY
Kavoussi
Louis R
LR
Solomon
Stephen B
SB
D000368:Aged; D000369:Aged, 80 and over; D017115:Catheter Ablation / Q000379:methods*; D015897:Comorbidity; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011856:Radiographic Image Enhancement; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome