Percutaneous Ablative Treatment of Renal Tumors in a Solitary Kidney: A Single-Center Experience

Objectives: To evaluate the safety, efficacy, functional outcomes, and local tumor control of ablation procedures for the treatment of renal T1a and T1b lesions in a solitary kidney. Methods: Sixty percutaneous ablative procedures of renal T1a and T1b lesions, in 25 patients with solitary kidney, were retrospectively analyzed: 26 (43.3%) procedures with radiofrequency ablation (RFA), 26 (43.3%) with cryoablation (CRA), and 8 (13.4%) with microwave ablation (MWA). Biopsy was performed for all the lesions. Efficacy of the treatment was evaluated as the absence of residual tumor immediately and on the 1 month after ablation. The secondary outcomes of interest included complications rate, disease-free survival (DFS), cancer-specific survival (CSS), overall survival (OS), and renal function. The correlation between tumor characteristics and the three treatment groups was conducted using Kruskal–Wallis test. The same test was also used to evaluate the correlation among DFS, CSS, OS, and renal function and the three treatment groups. Results: The mean age of the patients was 65.6 years (54–88 years); the mean tumor size was 19.3 mm (6–55). Fifty-nine lesions (96.7%) were T1a and two (3.3%) T1b. The mean RENAL nephrometry score was 5.5 (range, 4.0–10.0). Analyzing all the tumor characteristics among the three groups of treatments, lesion dimensions and the RENAL score significantly correlated with the procedural employed method with a P < 0.01, respectively. The treatment was effective in 96.7% of cases, with periprocedural major complications in only three patients (5%). In 1-year follow-up, 10 recurrences (16.7%) were documented: four (15.4%) for lesions treated with RFA, one (12.5%) with MWA, and five (19.2%) with CRA (P > 0.05). All recurrences were retreated with a consequent local tumor control. Analysis of renal function showed no significant changes between pre- and post-ablation creatinine levels. The only significant predictor of DFS in the multivariate analysis was the histotype, with a higher recurrence rate in RCC (P < 0.05). Conclusion: Our study found no significant differences in complications, renal function outcomes, and oncologic outcomes between the three ablative procedures for patients with a tumor in a solitary kidney. Patient selection, based on the tumor characteristics, remains crucial for the choice of the type of treatment.

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Artikel online veröffentlicht:
26. April 2021