title: Partial nephrectomy after previous radio frequency ablation: the National Cancer Institute experience.
abstract: OBJECTIVE
  Development of new renal tumors or recurrence after radio frequency ablation not amendable for repeat ablation presents a difficult therapeutic dilemma. We report on the outcomes of partial nephrectomy on kidneys previously treated with radio frequency ablation.
  
  
  METHODS
  We performed a chart review of 13 patients who underwent 16 attempted partial nephrectomies following radio frequency ablation. Hospital records and operative reports were reviewed for demographic data, perioperative data and outcomes. The outcomes of the present series were compared to historical controls of published studies in similar patient populations.
  
  
  RESULTS
  No cases were converted to radical nephrectomy. Median time from radio frequency ablation to surgery was 2.75 years (range 1 to 7.1). A median of 7 tumors (range 2 to 40) were removed with a median estimated blood loss of 1,500 ml (range 500 to 3,500) and a median operative time of 7.8 hours (range 5 to 10.7). Operative notes commented on the presence of severe fibrosis in the operative field in 12 of 16 cases (75%). There was a modest but statistically significant decrease in renal function. Partial nephrectomy after radio frequency ablation had a higher reoperation rate compared to other series of primary or repeat partial nephrectomies but had the lowest rate of vascular or visceral injuries.
  
  
  CONCLUSIONS
  Partial nephrectomy on kidneys previously treated with radio frequency ablation is a technically challenging but feasible procedure. Residual or metachronous disease after radio frequency ablation may be salvaged with partial nephrectomy with a modest decrease in renal function. A trend toward a higher chance of reoperation and urine leak after partial nephrectomy after radio frequency ablation may be useful information for the planning and discussion of treatment decisions.
authors.affiliation: Department of Health and Human Services, Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892-1107, USA.
authors.forename: Keith J
authors.initials: KJ
authors.lastname: Kowalczyk
authors.forename: H Brooks
authors.initials: HB
authors.lastname: Hooper
authors.forename: W Marston
authors.initials: WM
authors.lastname: Linehan
authors.forename: Peter A
authors.initials: PA
authors.lastname: Pinto
authors.forename: Bradford J
authors.initials: BJ
authors.lastname: Wood
authors.forename: Gennady
authors.initials: G
authors.lastname: Bratslavsky
mesh_terms: D000293:Adolescent; D000328:Adult; D017115:Catheter Ablation; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D054547:National Cancer Institute (U.S.); D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D009392:Nephrectomy / Q000379:methods*; D014481:United States; D055815:Young Adult