Percutaneous radiofrequency thermal ablation of renal cell carcinoma: is it possible a day-hospital treatment?
OBJECTIVE
The aim of this study is to evaluate the feasibility of the procedure in day-hospital and discuss prognostic factors, efficacy and complications of percutaneous radiofrequency ablation in the treatment of renal cell carcinoma.


METHODS
Between January 2003 and August 2008, 26 patients (mean age 79, range 70-87 years, 15 men and 11 women) affected by 27 kidney tumoral lesions, 25 RCC and two renal oncocitome (one patient was affected by two RCC), undergo 29 treatments of RFA (three patients underwent two treatments due to residual tumor at the CT performed 1 month after the first treatment). Three out of 26 patients had only one kidney due to progressed nephrectomy because of RCC; three/26 patients were carriers of oncological comorbidity while four/26 patients were carriers of medical comorbidity. The remaining 16/26 patients refused the surgical option. The lesions had a diameter between 1 and 4 cm (average diameter 2.4 cm). Seventeen of the 27 lesions were exophytic, five/27 parenchymal, three/27 was central while two/27 was mixed. All the lesions had been characterized either by CT or MRI. On the basis of the same investigation the feasibility of the radiofrequency procedure was verified. For all the procedures the RF type 3000 radiofrequency generator system was used together with the LeVeen ago-electrode. Twenty-one lesions out of 27 were treated under ultrasound guidance while six/27 lesions under the CT guide. After the procedure a US control was performed to exclude early complications and the same day the patients were discharged from hospital: the procedure was performed in day-hospital.


RESULTS
The technical success of the procedure was obtained in all cases (100%). After the procedure, 18 patients, without complications and comorbidity, were discharged from hospital the same day, seven patients with comorbidity were kept under observation for one night while one patient was hospitalized. The primary success of the treatment, rated with CT or MRI after 1 month, was obtained in 25/27 of the cases. In two/27 lesion, an incomplete ablation was obtained; for this reason these patients underwent a second treatment and after 6 month of a regular follow-up, no more neoplastic tissue was identified. During the follow-up there were no signs of disease in any patients. No major peri-procedural complications were recorded; only one patient had to be assisted for the appearance of a peri renal liquid (urinoma) and a thin pneumothorax layer that resolved completely in few days after the procedure.


CONCLUSIONS
Preliminary results with RFA of RCC are promising. Radiofrequency thermal ablation could prove to be a useful treatment for patients who are unsuitable for surgery; in this study we demonstrate the feasibility of the treatment in day-hospital for selected patients.
Carrafiello
Gianpaolo
G
Department of Radiology, University of Insubria, Varese, Italy. gcarraf@tin.it
Laganà
Domenico
D
Ianniello
Andrea
A
Mangini
Monica
M
Fontana
Federico
F
Cotta
Elisa
E
Concollato
Laura
L
Marconi
Alberto
A
Recaldini
Chiara
C
Dionigi
Gianlorenzo
G
Rovera
Francesca
F
Boni
Luigi
L
Cuffari
Salvatore
S
Fugazzola
Carlo
C
D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures / Q000379:methods*; D002292:Carcinoma, Renal Cell / Q000175:diagnosis / Q000601:surgery*; D017115:Catheter Ablation / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome