Room air dissection to protect the urinary tract during radiofrequency ablation of central small renal tumours

Congress:

ECR 2018

Poster Number:

C-1909

Type:

Scientific Exhibit

Keywords:

Kidney, Interventional non-vascular, Oncology, CT, Ablation procedures, Outcomes analysis, Technical aspects, Neoplasia, Outcomes

Authors:

A. Rudel, J. HAVET, X. Carle, J. BAQUE, P. Chevallier; Nice/FR

DOI:

10.1594/ecr2018/C-1909

DOI-Link:

https://dx.doi.org/10.1594/ecr2018/C-1909

Fig. 1: A/ Renal tumours close to the pelvic kidney (red arrow) , B/ Chiba needle by...

Fig. 2: Axial (A) and coronal (B) CT scanner showing an adequate air insulation of the...

Fig. 3: Table 1 Patient’s characteristics

Fig. 4: Table 2 Procedure characteristics

Aims and objectives

Radiofrequency ablation is used since more than 15 years in the treatment of T1a (< 4cm) renal tumours1. It allows to preserve long-term kidney function with favourable oncological outcomes. The incidental detection of renal cell carcinoma is increased by use of MRI and CT scanner2. Renal tumours close to the collecting system is a major risk factors of radiofrequency ablation complication in the literature3. It’s also an important criteria for partial nephrectomy included in Renal score. Some algorithms have been proposed for planning the percutaneous...

Methods and materials

It was a retrospective monocentric study including consecutive patients having a T1a central renal tumour with urinary tract contact (pelvis kidney or proximal ureter). All the treatment options were validated by a multidisciplinary board and informed consent was obtained for all patients . All procedures were performed with CT guidance (GE lightspeed) using RFA (Leveen needles) under general anaesthesia. Aerodissection was performed with room air injected through a 22 G needle placed close to the urinary tract.At the beginning of the procedure 2 ml of...

Results

-Population characteristics: Between 2010 and 2016 we performed urinal tract protection on 17 (6 women and 11 men) consecutive patients with renal tumours. The mean age was 70.9 years (range: 19-85). The mean diameter was 27.4 mm. Patient’s characteristics are resumed in table 1 (fig 3) At pathology , the final diagnosis was a renal clear cell carcinoma for 13 patients, a chromophobe cell carcinoma for two, an eosinophilic cell tumor for one patient and a papillary cell carcinoma for one patient. -Procedure characteristics: Technical...

Conclusion

Room air dissection is feasible and safe when performing RFA of T1a renal tumours situated close to the urinary tract. The major advantages of room air dissection is its low resorption rate with an adequate thermal isolation during all the duration of the RFA procedure and its simplicity to use it without any early septic or embolic complication in our preliminary experience .Recent studies provide proof of similar oncological outcomes between thermal ablation and partial nephrectomy with lower morbidity for percutaneous treatment8. Those studies may...

Personal information

References

1.Campbell, S. C. et al. Guideline for Management of the Clinical T1 Renal Mass. J. Urol. 182, 1271–1279 (2009). 2.Lightfoot, N. et al. Impact of Noninvasive Imaging on Increased Incidental Detection of Renal Cell Carcinoma. Eur. Urol. 37, 521–527 (2000). 3.McClure, T. D. et al. Intermediate Outcomes and Predictors of Efficacy in the Radiofrequency Ablation of 100 Pathologically Proven Renal Cell Carcinomas. J. Vasc. Interv. Radiol. 25, 1682–1688 (2014). 4.Schmit, G. D. et al. ABLATE: a renal ablation planning algorithm. AJR Am. J. Roentgenol. 202,...