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Technique of percutaneous, CT-guided radiofrequency ablation of small renal lesions under conscious sedation
S98
Urology/Reproductive Biology
CONCLUSIONS: Watchful waiting for renal masses is an appropriate option for appropriately selected patients–especially those with competing co-morbidities. Delayed intervention does not appear to adversely impact outcomes.
Technique of percutaneous, CT-guided radiofrequency ablation of small renal lesions under conscious sedation Jorge Arzola MAJ, USAF, MC, FS, Steven M. Baughman MAJ, USAF, MC, FS, Jay T Bishoff LTC, USAF, MC, Javier Hernandez LTC, USA, MS Wilford Hall Medical Center, Lackland AFB, TX INTRODUCTION: To determine the efficacy of CT-guided, resistance- based percutaneous radiofrequency ablation (PRFA) of renal malignancies using only conscious sedation. METHODS: Patients with peripherally based, enhancing renal masses and co-morbidities precluding standard surgical options were selected to undergo PRFA under conscious sedation. Patients were followed with renal function studies and enhanced imaging at 3-month intervals. Successful treatment was defined as lack of enhancement or resolution of the mass. RESULTS: From July 2001 to July 2005 we ablated 27 tumors in 23 patients with a mean follow-up of 24 months. The mean patient age was 74 years with a mode ASA score of 3. The mean renal mass size was 2.71 cm. The mean preoperative serum creatinine was 1.34, and the mean postoperative serum creatinine was 1.46, yielding a change which was not statistically different(p⫽0.46). Follow-up imaging revealed a 70%(16/23)initial success rate and a 17%(4/23)initial failure rate. Two of these failures underwent successful repeat ablation, 1 is on watchful waiting and 1 patient was a true failure. Our only complication was a large perinephric hematoma which resolved spontaneously. CONCLUSIONS: PRFA is easily facilitated though CT-guidance and is well tolerated using only conscious sedation. We noted no significant changes in renal function and demonstrated promising
J Am Coll Surg
oncological results at 2 year follow-up. Having noted poor results with tumors ⬎4.5 cm, we recommend performing longer term studies before patient and renal mass criteria can be expanded.
Peripheral temperature monitoring for laparoscopic and CT-guided radio frequency ablation of renal masses Robert I Carey MD, PhD, Leveillee Raymond MD, Bird Vincent MD University of Miami, Miami, FL INTRODUCTION: We describe laparoscopic and CT guided radio frequency ablation (RFA) using peripheral temperature monitoring. METHODS: Patients undergoing RFA for renal masses were retrospectively evaluated. We perform peripheral temperature monitoring with fiberoptic, non-conductive, 200 micron thermistors placed at the periphery of the tumor. Ablations continue until the tissue temperature exceeds 60oC in all thermistors. RESULTS: 90 patients underwent RFA of 96 tumors between 12/ 2001 and 12/2005. 40 tumors were ablated via laparoscopy and 56 tumors with CT guidance. Mean age was 68.2 years (range 38-84), and median age 70 years. Mean tumor size was 2.57 cm (1.5-5.0). 39 tumors were greater than 3 cm. Tumor polar location was equally distributed. The Cool-tip™ device (Valley Lab, Boulder, CO) and the RITA™ system (RITA Medical, Mountain View, CA) were used to treat 62 and 34 tumors, respectively. Mean follow-up was 10.0 months (1 – 48). 23 patients have greater than 12 month follow-up imaging. Radiographic success rate was 93.75%. Six patients have shown radiographic enhancement (⬎20 HU by CT or by interpretation of MRI) and four have been retreated. Pathologic specimens from one radical nephrectomy, one partial nephrectomy, and two biopsies have shown no evidence of residual tumor. CONCLUSIONS: RFA of renal tumors has a high radiologic success rate. Peripheral temperature monitoring may provide a better indicator of RFA success than follow-up imaging. Long-term radiologic and pathologic follow-up is necessary to determine the oncologic efficacy of this ablative therapy.
Urology/Reproductive Biology
CONCLUSIONS: Watchful waiting for renal masses is an appropriate option for appropriately selected patients–especially those with competing co-morbidities. Delayed intervention does not appear to adversely impact outcomes.
Technique of percutaneous, CT-guided radiofrequency ablation of small renal lesions under conscious sedation Jorge Arzola MAJ, USAF, MC, FS, Steven M. Baughman MAJ, USAF, MC, FS, Jay T Bishoff LTC, USAF, MC, Javier Hernandez LTC, USA, MS Wilford Hall Medical Center, Lackland AFB, TX INTRODUCTION: To determine the efficacy of CT-guided, resistance- based percutaneous radiofrequency ablation (PRFA) of renal malignancies using only conscious sedation. METHODS: Patients with peripherally based, enhancing renal masses and co-morbidities precluding standard surgical options were selected to undergo PRFA under conscious sedation. Patients were followed with renal function studies and enhanced imaging at 3-month intervals. Successful treatment was defined as lack of enhancement or resolution of the mass. RESULTS: From July 2001 to July 2005 we ablated 27 tumors in 23 patients with a mean follow-up of 24 months. The mean patient age was 74 years with a mode ASA score of 3. The mean renal mass size was 2.71 cm. The mean preoperative serum creatinine was 1.34, and the mean postoperative serum creatinine was 1.46, yielding a change which was not statistically different(p⫽0.46). Follow-up imaging revealed a 70%(16/23)initial success rate and a 17%(4/23)initial failure rate. Two of these failures underwent successful repeat ablation, 1 is on watchful waiting and 1 patient was a true failure. Our only complication was a large perinephric hematoma which resolved spontaneously. CONCLUSIONS: PRFA is easily facilitated though CT-guidance and is well tolerated using only conscious sedation. We noted no significant changes in renal function and demonstrated promising
J Am Coll Surg
oncological results at 2 year follow-up. Having noted poor results with tumors ⬎4.5 cm, we recommend performing longer term studies before patient and renal mass criteria can be expanded.
Peripheral temperature monitoring for laparoscopic and CT-guided radio frequency ablation of renal masses Robert I Carey MD, PhD, Leveillee Raymond MD, Bird Vincent MD University of Miami, Miami, FL INTRODUCTION: We describe laparoscopic and CT guided radio frequency ablation (RFA) using peripheral temperature monitoring. METHODS: Patients undergoing RFA for renal masses were retrospectively evaluated. We perform peripheral temperature monitoring with fiberoptic, non-conductive, 200 micron thermistors placed at the periphery of the tumor. Ablations continue until the tissue temperature exceeds 60oC in all thermistors. RESULTS: 90 patients underwent RFA of 96 tumors between 12/ 2001 and 12/2005. 40 tumors were ablated via laparoscopy and 56 tumors with CT guidance. Mean age was 68.2 years (range 38-84), and median age 70 years. Mean tumor size was 2.57 cm (1.5-5.0). 39 tumors were greater than 3 cm. Tumor polar location was equally distributed. The Cool-tip™ device (Valley Lab, Boulder, CO) and the RITA™ system (RITA Medical, Mountain View, CA) were used to treat 62 and 34 tumors, respectively. Mean follow-up was 10.0 months (1 – 48). 23 patients have greater than 12 month follow-up imaging. Radiographic success rate was 93.75%. Six patients have shown radiographic enhancement (⬎20 HU by CT or by interpretation of MRI) and four have been retreated. Pathologic specimens from one radical nephrectomy, one partial nephrectomy, and two biopsies have shown no evidence of residual tumor. CONCLUSIONS: RFA of renal tumors has a high radiologic success rate. Peripheral temperature monitoring may provide a better indicator of RFA success than follow-up imaging. Long-term radiologic and pathologic follow-up is necessary to determine the oncologic efficacy of this ablative therapy.