Laparoscopic radiofrequency ablation with intraoperative contrast-enhanced ultrasonography for T1bN0M0 renal tumors: Initial functional and oncologic outcomes

摘要

Purpose: To assess the functional and oncologic outcomes of laparoscopic radiofrequency ablation (RFA) with intraoperative contrast-enhanced ultrasonography in treatment of T1b renal tumors. Patients and Methods: We performed a retrospective review of 51 patients with unilateral T1b renal tumors who underwent laparoscopic RFA from January 2007 to April 2012 with a mean follow-up of 31.5 months. The tumors were laparoscopically dissected and ablated with cool-tip RFA system under the guidance of contrast-enhanced ultrasound. Routine follow-up included contrast-enhanced computed tomography/magnetic resonance imaging (CT/MRI) and renal function tests. Results: Mean diameter of the treated renal tumors was 5.1 cm (range 4.1-6.4 cm). Initial ablation success rate was 46/51 (90.2%). Of five incompletely ablated patients, four experienced up to two additional sessions of percutaneous RFA and achieved complete ablation. After at least 12 months contrast-enhanced CT/MRI follow-up after RFA, one patient experienced local tumor recurrence and another developed pulmonary and bone metastases. The 3-year disease-free survival in patients with biopsy-proven cancer was 85.7%. There was no significant difference between the estimated glomerular filtration rate (eGFR) pre- and post-RFA. Mean change in eGFR following RFA was -2.2 mL/minute. No patients required dialysis in the periprocedural period. Major complications (≥Grade 3) only developed in two (3.9%) cases. Conclusions: Our initial experience with this technique in T1b renal tumors was favorable with good renal function preservation and oncologic outcomes. It may be a good alternative to partial nephrectomy for selected T1b renal tumors.