Percutaneous microwave ablation of renal masses in a UK cohort

Abstract

Objectives To report a tertiary referral centre’s experience of microwave ablation (MWA) for suspected renal cell carcinoma (RCC), describing complications and oncological outcomes. Patients and Methods Consecutive MWA procedures (n = 113) for renal masses (October 2016 to September 2019) were maintained on a prospective database. Data describing patient, disease, procedure, complications, and oncological outcomes were analysed. Results The median (range) age was 68 (33–85) years, 73% were male, and the median Charlson Comorbidity Index was 0. The median (interquartile range [IQR]) tumour diameter was 25 (20–32) mm. In all, 95% had renal mass biopsy, with histologically confirmed cancer in 75%. The median (IQR) R.E.N.A.L. (Radius, Exophytic/Endophytic, Nearness, Anterior/Posterior, Location) nephrometry score was 7 (6–8). The median ablation time was 6 min and length of stay was 1 day for 95% of the patients. Clavien–Dindo complication Grades I, II, IIIb and IV occurred in 18%, 1.8%, 0.9% and 0.9%, respectively. The median follow‐up was 12 months and the median (IQR) renal function change was −4 (−18 to 0)%. One patient (0.9%) had local recurrence, treated with re‐ablation; two developed metastatic progression; and two (1.8%) had indeterminate findings on follow‐up (one lung nodule and one possible local recurrence), managed with ongoing protocolised computed tomography surveillance. Post‐procedure complications were associated with total ablation time (odds ratio [OR] 1.152/min, 95% confidence interval [CI] 1.040–1.277) and total ablation energy (OR 1.017/kJ, 95% CI 1.001–1.033). Conclusions We describe the largest UK series of MWA treatment for T1a/small T1b renal masses to date. MWA was well tolerated, with 95% discharged the following day and low complication/re‐admission rates. Current follow‐up demonstrates favourable disease control. MWA appears to be safe and effective and should be considered in future prospective comparisons of treatments for T1a/small T1b renal masses.

Contemporary standards in UK nephrectomy practice: Analysis of the British Association of Urological Surgeons Complex Operations Reports, 2016–2018

“…The adoption of watchful waiting, active surveillance or minimally invasive interventions for certain renal masses, and risk from major surgery, may explain why a minority of patients who undergo surgery have an ASA grade of 3 or more. [2][3][4][5] In total, 92.4% of patients undergoing nephrectomy were 80 or younger -identical to that seen in series of 672 patients in Pakistan from 2018 undergoing RN or PN. 6 The BAUS database used the ASA grade to describe patient's physical status, and 22.5% were reported as ASA 3-4.…”

“…The adoption of watchful waiting, active surveillance or minimally invasive interventions for certain renal masses, and risk from major surgery, may explain why a minority of patients who undergo surgery have an ASA grade of 3 or more. 2–5…”

Perkutane lokal-ablative Therapie beim kleinen Nierenzellkarzinom

“…In jüngeren Studien mit einem kürzeren mittleren Follow-up von 12-24 Monaten konnte für die Behandlung von T1a Tumoren ein lokales Progressionsfreies bzw. Rezidivfreies 12-Monatsüberleben von 98 bis 100 % aufgezeigt werden [26,27]. che als nicht geeignet für ein chirurgisches Vorgehen eingestuft werden.…”

Perkutane lokal-ablative Therapie beim kleinen Nierenzellkarzinom

“…In jüngeren Studien mit einem kür-zeren mittleren Follow-up von 12-24 Monaten konnte für die Behandlung von T1a Tumoren ein lokales Progressionsfreies bzw. Rezidivfreies 12-Monatsüberleben von 98 bis 100 % aufgezeigt werden [26,27].…”