General Anesthesia and Contrast-Enhanced Computed Tomography to Optimize Renal Percutaneous Radiofrequency Ablation: Multi-Institutional Intermediate-Term Results

Abstract

Intermediate-term outcomes of percutaneous RFA are excellent. GA-assisted, contrast-enhanced CT-guided percutaneous RFA demonstrates a high initial ablation success rate. However, endophytic and interpolar lesions are at higher risk for recurrence.

Percutaneous Cryoablation of Renal Masses ≥3 cm: Efficacy and Safety in Treatment of 108 Patients

“…[7][8][9][10][11] Reasons for this may include: (1) We have an experienced multidisciplinary team of urologists and radiologists who carefully select ablation cases that are highly likely to be successful; (2) we have a lot of experience with performing percutaneous renal cryoablations; (3) real-time ultrasonographic guidance is used for the procedures in addition to CT, which allows precise placement of the cryoprobes within the renal tumor; and (4) we perform all renal cryoablations with the patients under general anesthesia, which has been shown to improve results compared with those performed with moderate sedation. 23 Although commonly accepted criteria for a technically unsuccessful ablation (residual disease) and locally recurrent tumor (recurrent disease) were used in this study, the 3-month cutoff between residual and recurrent tumor is still somewhat arbitrary and confusing. 24 Initial determination of a technically unsuccessful ablation was actually made on the 3-month follow-up CT for all three patients in this study group.…”

The Importance of Nephron-Sparing Focal Therapy: Renal Function Preservation

“…Further, though many series included in the metaanalysis treated patients with RFA under conscious sedation, there is evidence to suggest that results can be improved using general anesthesia, with initial ablation success rates reaching 97%. 37 Further complicating such analyses, often patients treated with cryoablation are substantially different from those treated with RFA. For example, Hegarty and coworkers 38 report rates of disease persistence in 1.8% of lesions treated with cryoablation versus 11.1% of lesions treated with RFA.…”

Laparoscopic and Image-guided Radiofrequency Ablation of Renal Tumors: Patient Selection and Outcomes

“…Most ablations are performed in patients with small renal masses (SRM; <4 cm). Mean tumor sizes in RFA series range from 1.7 to 3.8 cm [26,[28][29][30][31][32][33][34][35][36]. About 80% of resected SRMs are malignant [37]; however, biopsy results in RFA series have shown RCC in 48% to 91% of studies [6, 10••, 26, 29], with some series reporting exclusively malignant tumors [36,38].…”