Radiofrequency ablation of small renal cortical tumours in healthy adults: renal function preservation and intermediate oncological outcome.
OBJECTIVE
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.


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)).


CONCLUSIONS
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.
Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Joshua M
JM
Stern
Amit
A
Gupta
Jay D
JD
Raman
Nicholas
N
Cost
Steven
S
Lucas
Yair
Y
Lotan
Ganesh V
GV
Raj
Jeffrey A
JA
Cadeddu
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008058:Dihydrolipoamide Dehydrogenase / Q000378:metabolism; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D007668:Kidney / Q000502:physiology*; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
D008058:Dihydrolipoamide Dehydrogenase