Protecting the ureter during radiofrequency ablation of renal cell cancer: a pilot study of retrograde pyeloperfusion with cooled dextrose 5% in water.
OBJECTIVE
To describe early experience with cooled dextrose 5% in water (D5W) solution retrograde pyeloperfusion during radiofrequency (RF) ablation of renal cell carcinoma (RCC) within 1.5 cm of the ureter with respect to feasibility, safety, and incidence of residual/recurrent tumor in proximity to the cooled collecting system.


METHODS
Between November 2004 and April 2007, 17 patients underwent 19 RF ablation sessions of RCCs within 1.5 cm of the ureter during cooled D5W pyeloperfusion (nine men, eight women; mean tumor size, 3.5 cm; mean age, 73 y; mean distance to ureter, 7 mm). RF ablation was performed with pulsed impedance control current. The records and imaging studies of patients treated with this technique were reviewed for demographics, indication, technique, complications, and tumor recurrence.


RESULTS
All 19 RF ablation and ureteral catheter placement procedures were technically successful. No patient developed a ureteral stricture or hydronephrosis during a mean of 14 months of follow-up (range, 4-32 months). Three patients had residual tumor on the first follow-up imaging study, but all three tumors were completely ablated after a second RF ablation session. No complications or deaths occurred. No recurrent tumor was seen anywhere in the treated tumors, and there was complete ablation of the tumor margin in proximity to the collecting system.


CONCLUSIONS
RF ablation of RCC within 1.5 cm of the ureter is feasible with cooled D5W retrograde pyeloperfusion and is not associated with reduced efficacy, ureteral injury, or early recurrence.
Cantwell
Colin P
CP
Division of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
Wah
Tze M
TM
Gervais
Debra A
DA
Eisner
Brian H
BH
Arellano
Ronald
R
Uppot
Raul N
RN
Samir
Anthony E
AE
Irving
Henry C
HC
McGovern
Francis
F
Mueller
Peter R
PR
D000368:Aged; D001900:Boston; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D003080:Cold Temperature; D004739:England; D005240:Feasibility Studies; D005260:Female; D005947:Glucose / Q000627:therapeutic use*; D006801:Humans; D006869:Hydronephrosis / Q000209:etiology / Q000517:prevention & control; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D009364:Neoplasm Recurrence, Local; D018365:Neoplasm, Residual; D010477:Perfusion; D010865:Pilot Projects; D012086:Reoperation; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014515:Ureteral Diseases / Q000209:etiology / Q000517:prevention & control*; D014546:Urinary Catheterization
D005947:Glucose