Renal Tumor Ablation Via the Liver Is Safe, Effective

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Intratumor Heterogeneity Seen in Renal Carcinomas
Researchers show that ultrasound-guided radiofrequency ablation is technically feasible.

Percutaneous ultrasound-guided transhepatic radiofrequency ablation (RFA) of renal tumors is technically feasible and oncologically efficacious, according to investigators. It also is associated with a low complication rate.

“The transhepatic approach may allow safe ablation of renal tumors that would otherwise be difficult to treat,” a team at Mayo Clinic in Rochester, Minn., led by Thomas D. Atwell, MD, concluded in a paper published in Cardiovascular and Interventional Radiology (2014;37:508-512)..

Dr. Atwell and his colleagues pointed out that some renal tumors are in locations not easily accessed directly by conventional approaches. “When treating masses in the right kidney, overlying bowel or inflated lung can limit safe introduction of the RFA applicator,” they explained. “In addition, respiratory-related motion of a renal mass may make accurate applicator placement challenging.”

Because of the anatomic relationship of the liver and right kidney, they noted, a percutaneous transhepatic approach can be used to place the RFA applicator, obviating concerns related to bowel and lung. “Using real-time ultrasound guidance, the proceduralist can account for respiratory motion, allowing precise applicator placement,” they stated.

In a study, Dr. Atwell's group used transhepatic renal RFA to treat 19 tumors in 18 patients. The tumors had a median maximal diameter of 1.9 cm. No major complications developed during any of the procedures. No hepatic tumor seeding was identified during imaging follow-up.

Imaging follow-up with computed tomography or magnetic resonance imaging was available for 16 patients at a median of 28 months. A single technique failure occurred in the treatment of a 3.0 cm tumor.

The study had some limitations, including a small study population and relatively short follow-up for oncologic outcomes, the researchers stated.

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