Irreversible Electroporation for Surgical Renal Masses in Solitary Kidneys: Short-Term Interventional and Functional Outcome.
OBJECTIVE
To examine short-term outcomes and complications in patients with a solitary kidney treated with irreversible electroporation (IRE) for a potentially malignant renal mass.


METHODS
Five patients (2 female, 3 male; mean age, 66 y) with 7 lesions who underwent IRE for renal tumors in a solitary kidney between August 2014 and August 2015 were retrospectively reviewed. Changes in signal intensity (SI) of the treated lesion were evaluated on contrast-enhanced magnetic resonance imaging. To evaluate functional outcome, creatinine levels and estimated glomerular filtration rate (eGFR) were compared vs baseline after 1 day, 2-7 days, 3-6 weeks, and 6-12 weeks after the intervention.


RESULTS
Mean tumor diameter was 24.4 mm (range, 15-38 mm), with an average score of 7.7 (range, 4-9) per R.E.N.A.L. criteria (radius, exophytic/endophytic, nearness to collecting system or sinus, anterior/posterior, and location relative to polar lines). There was a progressive, significant decrease in treated tumor SI on follow-up imaging (mean, 70%-82%), suggesting a treatment response rate of 100% at a mean follow-up of 6.4 months (range, 3-11 mo). Two minor acute complications (Society of Interventional Radiology class A) occurred: transient gross hematuria and stage I acute kidney failure. Overall, there was no significant decrease in eGFR (-2.75 mL/min) over 3 months, even though 1 patient's eGFR decreased from > 60 mL/min/1.73m(2) to 44 mL/min/1.73m(2).


CONCLUSIONS
The data suggest that percutaneous IRE for renal mass in patients with a solitary kidney is safe and feasible. It may help to preserve renal function and offers promising short-term oncologic results.
Institute of Clinical Radiology and Nuclear Medicine, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany.
Steffen J
SJ
Diehl
Institute of Clinical Radiology and Nuclear Medicine, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany. Electronic address: nils.rathmann@umm.de.
Nils
N
Rathmann
Institute of Clinical Radiology and Nuclear Medicine, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany.
Michael
M
Kostrzewa
Department of Urology, University Medical Center Mannheim, Medical Faculty Mannheim-Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany.
Manuel
M
Ritter
Institute of Clinical Radiology and Nuclear Medicine, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany.
Arman
A
Smakic
Institute of Clinical Radiology and Nuclear Medicine, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany.
Stefan O
SO
Schoenberg
Department of Urology, University Medical Center Mannheim, Medical Faculty Mannheim-Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany.
Maximilian C
MC
Kriegmair
D055011:Ablation Techniques / Q000009:adverse effects / Q000401:mortality; D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood; D018274:Electroporation; D005240:Feasibility Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006417:Hematuria / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden
D015415:Biomarkers; D003404:Creatinine