title: Image guided percutaneous probe ablation for renal tumors in 65 solitary kidneys: functional and oncological outcomes.
abstract: OBJECTIVE
  We evaluated the oncological and functional outcomes of computerized tomography guided percutaneous cryotherapy or radio frequency ablation of kidney tumors in patients with a solitary kidney.
  
  
  METHODS
  We reviewed the medical charts of patients with a solitary kidney who underwent percutaneous probe ablation for renal masses at our institution from April 2002 through March 2010. Followup consisted of computerized tomography or magnetic resonance imaging 1 day postoperatively, at 3, 6 and 12 months, and annually thereafter. Serum creatinine and estimated glomerular filtration rate were used to measure renal function. The cryotherapy and radio frequency ablation groups were compared for demographics, the 2-year actuarial survival rate and renal function.
  
  
  RESULTS
  Overall 65 patients were included in this retrospective analysis, of whom 29 (44.6%) underwent cryotherapy and 36 (55.4%) underwent radio frequency ablation. Median followup was 15.1 (IQR 4.4 to 32.9) and 38.8 months (13.8 to 50.7), respectively. The 2 groups were comparable in median age, body mass index, American Society of Anesthesiologists score, tumor size and preoperative estimated glomerular filtration rate. The 3 primary treatment failures, including 1 after cryotherapy and 2 after radio frequency ablation, were successfully re-treated with thermal ablation. There were 14 recurrences after radio frequency ablation and 3 after cryotherapy. Two-year actuarial overall, cancer specific, recurrence-free and metastasis-free survival rates for cryotherapy vs radio frequency ablation were 89% vs 93%, 100% vs 96%, 69% vs 58% and 86% vs 91%, respectively. For each group no significant decrease in renal functional parameters was found at the latest followup visit.
  
  
  CONCLUSIONS
  Computerized tomography guided percutaneous probe ablation represents a safe treatment option in surgical patients at high risk with a solitary kidney. It provides low morbidity, acceptable short-term cancer control and minimal clinical impact on postoperative renal function.
authors.affiliation: Section of Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Fatih
authors.initials: F
authors.lastname: Altunrende
authors.forename: Riccardo
authors.initials: R
authors.lastname: Autorino
authors.forename: Shahab
authors.initials: S
authors.lastname: Hillyer
authors.forename: Bo
authors.initials: B
authors.lastname: Yang
authors.forename: Humberto
authors.initials: H
authors.lastname: Laydner
authors.forename: Michael A
authors.initials: MA
authors.lastname: White
authors.forename: Rakesh
authors.initials: R
authors.lastname: Khanna
authors.forename: Wahib
authors.initials: W
authors.lastname: Isac
authors.forename: Gregory
authors.initials: G
authors.lastname: Spana
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stein
authors.forename: Georges-Pascal
authors.initials: GP
authors.lastname: Haber
authors.forename: Charles M
authors.initials: CM
authors.lastname: O'Malley
authors.forename: Erick M
authors.initials: EM
authors.lastname: Remer
authors.forename: Jihad H
authors.initials: JH
authors.lastname: Kaouk
mesh_terms: D000368:Aged; D017115:Catheter Ablation; D017679:Cryotherapy; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D015641:Radiography, Interventional; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome