General anesthesia and contrast-enhanced computed tomography to optimize renal percutaneous radiofrequency ablation: Multi-institutional intermediate-term results

Amit Gupta, Jay D. Raman, Raymond J. Leveillee, Marshall S. Wingo, Ilia S. Zeltser, Yair Lotan, Clayton Trimmer, Joshua M. Stern, Jeffrey A. Cadeddu

Research output: Contribution to journalArticle

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Abstract

Introduction: Percutaneous renal ablation is often performed under conscious sedation and without contrast-enhanced imaging. We evaluated intermediate-term outcomes of patients undergoing percutaneous contrast-enhanced computed tomography (CT)-guided radiofrequency ablation (RFA) under general anesthesia (GA) at two high-volume centers. Materials and Methods: Prospectively maintained Institutional Regulatory Board-approved databases were searched to identify patients treated with percutaneous RFA using contrast-enhanced CT under GA. A total of 163 masses in 151 patients were treated. Enhancement on imaging or a positive biopsy at 4 to 6 weeks was considered incomplete ablation. Positive findings beyond this interval were defined as local recurrence. Results: The median follow-up was 18 months (range, 1.5-70). Median tumor size was 2.3 cm (range, 1-5.4). Of the 130 (80%) masses with definitive pathology, 70% were renal cell cancer. Five masses had evidence of viable tumor at 4 to 6 weeks posttreatment for a complete initial ablation rate of 97%. Three of these five lesions were endophytic. Five masses (3.3%) showed evidence of local recurrence, and metastases developed in two patients (1.3%). Overall 1- and 3-year recurrence-free survival was 97% and 92%, respectively. Masses that were in the central region and were endophytic had the highest risk for recurrence (hazard ratio, 6.3; p=0.016). Conclusions: 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.

Original languageEnglish
Pages (from-to)1099-1105
Number of pages7
JournalJournal of Endourology
Volume23
Issue number7
DOIs
StatePublished - Jul 1 2009
Externally publishedYes

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General Anesthesia
Tomography
Kidney
Recurrence
Conscious Sedation
Renal Cell Carcinoma
Neoplasms
Databases
Pathology
Neoplasm Metastasis
Biopsy
Survival

ASJC Scopus subject areas

  • Urology

Cite this

General anesthesia and contrast-enhanced computed tomography to optimize renal percutaneous radiofrequency ablation : Multi-institutional intermediate-term results. / Gupta, Amit; Raman, Jay D.; Leveillee, Raymond J.; Wingo, Marshall S.; Zeltser, Ilia S.; Lotan, Yair; Trimmer, Clayton; Stern, Joshua M.; Cadeddu, Jeffrey A.

In: Journal of Endourology, Vol. 23, No. 7, 01.07.2009, p. 1099-1105.

Research output: Contribution to journalArticle

Gupta, A, Raman, JD, Leveillee, RJ, Wingo, MS, Zeltser, IS, Lotan, Y, Trimmer, C, Stern, JM & Cadeddu, JA 2009, 'General anesthesia and contrast-enhanced computed tomography to optimize renal percutaneous radiofrequency ablation: Multi-institutional intermediate-term results', Journal of Endourology, vol. 23, no. 7, pp. 1099-1105. https://doi.org/10.1089/end.2008.0499
Gupta, Amit ; Raman, Jay D. ; Leveillee, Raymond J. ; Wingo, Marshall S. ; Zeltser, Ilia S. ; Lotan, Yair ; Trimmer, Clayton ; Stern, Joshua M. ; Cadeddu, Jeffrey A. / General anesthesia and contrast-enhanced computed tomography to optimize renal percutaneous radiofrequency ablation : Multi-institutional intermediate-term results. In: Journal of Endourology. 2009 ; Vol. 23, No. 7. pp. 1099-1105.
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abstract = "Introduction: Percutaneous renal ablation is often performed under conscious sedation and without contrast-enhanced imaging. We evaluated intermediate-term outcomes of patients undergoing percutaneous contrast-enhanced computed tomography (CT)-guided radiofrequency ablation (RFA) under general anesthesia (GA) at two high-volume centers. Materials and Methods: Prospectively maintained Institutional Regulatory Board-approved databases were searched to identify patients treated with percutaneous RFA using contrast-enhanced CT under GA. A total of 163 masses in 151 patients were treated. Enhancement on imaging or a positive biopsy at 4 to 6 weeks was considered incomplete ablation. Positive findings beyond this interval were defined as local recurrence. Results: The median follow-up was 18 months (range, 1.5-70). Median tumor size was 2.3 cm (range, 1-5.4). Of the 130 (80{\%}) masses with definitive pathology, 70{\%} were renal cell cancer. Five masses had evidence of viable tumor at 4 to 6 weeks posttreatment for a complete initial ablation rate of 97{\%}. Three of these five lesions were endophytic. Five masses (3.3{\%}) showed evidence of local recurrence, and metastases developed in two patients (1.3{\%}). Overall 1- and 3-year recurrence-free survival was 97{\%} and 92{\%}, respectively. Masses that were in the central region and were endophytic had the highest risk for recurrence (hazard ratio, 6.3; p=0.016). Conclusions: 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.",
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AU - Raman, Jay D.

AU - Leveillee, Raymond J.

AU - Wingo, Marshall S.

AU - Zeltser, Ilia S.

AU - Lotan, Yair

AU - Trimmer, Clayton

AU - Stern, Joshua M.

AU - Cadeddu, Jeffrey A.

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N2 - Introduction: Percutaneous renal ablation is often performed under conscious sedation and without contrast-enhanced imaging. We evaluated intermediate-term outcomes of patients undergoing percutaneous contrast-enhanced computed tomography (CT)-guided radiofrequency ablation (RFA) under general anesthesia (GA) at two high-volume centers. Materials and Methods: Prospectively maintained Institutional Regulatory Board-approved databases were searched to identify patients treated with percutaneous RFA using contrast-enhanced CT under GA. A total of 163 masses in 151 patients were treated. Enhancement on imaging or a positive biopsy at 4 to 6 weeks was considered incomplete ablation. Positive findings beyond this interval were defined as local recurrence. Results: The median follow-up was 18 months (range, 1.5-70). Median tumor size was 2.3 cm (range, 1-5.4). Of the 130 (80%) masses with definitive pathology, 70% were renal cell cancer. Five masses had evidence of viable tumor at 4 to 6 weeks posttreatment for a complete initial ablation rate of 97%. Three of these five lesions were endophytic. Five masses (3.3%) showed evidence of local recurrence, and metastases developed in two patients (1.3%). Overall 1- and 3-year recurrence-free survival was 97% and 92%, respectively. Masses that were in the central region and were endophytic had the highest risk for recurrence (hazard ratio, 6.3; p=0.016). Conclusions: 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.

AB - Introduction: Percutaneous renal ablation is often performed under conscious sedation and without contrast-enhanced imaging. We evaluated intermediate-term outcomes of patients undergoing percutaneous contrast-enhanced computed tomography (CT)-guided radiofrequency ablation (RFA) under general anesthesia (GA) at two high-volume centers. Materials and Methods: Prospectively maintained Institutional Regulatory Board-approved databases were searched to identify patients treated with percutaneous RFA using contrast-enhanced CT under GA. A total of 163 masses in 151 patients were treated. Enhancement on imaging or a positive biopsy at 4 to 6 weeks was considered incomplete ablation. Positive findings beyond this interval were defined as local recurrence. Results: The median follow-up was 18 months (range, 1.5-70). Median tumor size was 2.3 cm (range, 1-5.4). Of the 130 (80%) masses with definitive pathology, 70% were renal cell cancer. Five masses had evidence of viable tumor at 4 to 6 weeks posttreatment for a complete initial ablation rate of 97%. Three of these five lesions were endophytic. Five masses (3.3%) showed evidence of local recurrence, and metastases developed in two patients (1.3%). Overall 1- and 3-year recurrence-free survival was 97% and 92%, respectively. Masses that were in the central region and were endophytic had the highest risk for recurrence (hazard ratio, 6.3; p=0.016). Conclusions: 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.

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