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Lee JY, Yang SW, Lim JS. Advocating laparoscopic radiofrequency ablation as an optimal treatment for small renal cell carcinoma in special patient populations. Investig Clin Urol 2023; 64:510-511. [PMID: 37668208 PMCID: PMC10482660 DOI: 10.4111/icu.20230262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 08/16/2023] [Indexed: 09/06/2023] Open
Affiliation(s)
- Ji Yong Lee
- Department of Urology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Seung Woo Yang
- Department of Urology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
- Department of Urology, U-Well Urology Clinic, Daejeon, Korea
| | - Jae Sung Lim
- Department of Urology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea.
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Nagata C, Fujimori M, Yamanaka T, Sugino Y, Matsushita N, Kishi S, Fukui H, Omori Y, Nishikawa K, Sakuma H. Percutaneous Thermal Ablation for Managing Small Renal Metastatic Tumors. INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2022; 7:85-92. [PMID: 36483663 PMCID: PMC9719821 DOI: 10.22575/interventionalradiology.2021-0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/12/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE To retrospectively evaluate the treatment outcomes of thermal ablation for renal metastatic tumors. MATERIALS AND METHODS Thirteen consecutive patients with small renal metastatic tumors (≤3 cm), who underwent thermal ablation between 2009 and 2020, were included in this study. Eight patients had extra-renal tumors during renal ablation. The primary tumors were adenoid cystic carcinoma in four patients, lung cancer in three, hemangiopericytoma in three, leiomyosarcoma in two, and thyroid cancer in one. The therapeutic effects, safety, survival rate, prognostic factor, and renal function were evaluated. RESULTS We performed 18 ablation sessions (cryoablation, n = 13; radiofrequency ablation, n = 5) on 19 renal metastases with a mean diameter of 1.7 cm, which resulted in a primary technique efficacy rate of 100% without procedure-related deaths or major complications. Renal function significantly declined 6 months after ablation (P = 0.0039). During the mean follow-up period of 31.2 ± 22.4 months (range, 2.7-71.4 months), one patient had local tumor progression at 11.9 months following radiofrequency ablation. The overall survival rates at 1 and 3 years after ablation were 76.9% (95% confidence interval [CI], 54.0%-99.8%) and 59.3% (95% CI, 31.3%-87.3%), respectively. Tumor size ≥ 2 cm (P = 0.02) and metastasis from non-small cell lung cancer (P = 0.001) were significant worse prognostic factors in univariate analysis, and metastasis from non-small cell lung cancer (P = 0.01) was significant in multivariate analysis. CONCLUSIONS Percutaneous thermal ablation for small renal metastases is safe and feasible and can control local tumors.
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Affiliation(s)
- Chisami Nagata
- Department of Radiology, Mie University School of Medicine, Japan
| | - Masashi Fujimori
- Department of Radiology, Mie University School of Medicine, Japan
| | - Takashi Yamanaka
- Department of Radiology, Mie University School of Medicine, Japan
| | - Yuichi Sugino
- Department of Radiology, Mie University School of Medicine, Japan
| | | | - Seiya Kishi
- Department of Radiology, Mie University School of Medicine, Japan
| | - Hikari Fukui
- Department of Radiology, Mie University School of Medicine, Japan
| | - Yuki Omori
- Department of Radiology, Mie University School of Medicine, Japan
| | - Kohei Nishikawa
- Department of Nephro-Urologic Surgery and Andrology, Mie University School of Medicine, Japan
| | - Hajime Sakuma
- Department of Radiology, Mie University School of Medicine, Japan
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Fujimori M, Yamanaka T, Sugino Y, Matsushita N, Sakuma H. Percutaneous Image-guided Thermal Ablation for Renal Cell Carcinoma. INTERVENTIONAL RADIOLOGY 2020; 5:32-42. [PMID: 36284654 PMCID: PMC9550385 DOI: 10.22575/interventionalradiology.2020-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 03/17/2020] [Indexed: 11/05/2022]
Abstract
Nephrectomy is the gold standard for the treatment of renal cell carcinoma (RCC). However, some patients are not suitable candidates for nephrectomy because of high surgical risk, reduced renal function, or the presence of multiple renal tumors. Percutaneous image-guided thermal ablation, including cryoablation and radiofrequency ablation, is a minimally invasive and highly effective treatment and can be used to treat RCC in patients who are not good candidates for surgery. This article will review percutaneous image-guided thermal ablation for RCC, covering treatment indications, ablation modalities and techniques, oncologic outcomes, and possible complications. In addition, the characteristics of each ablation modality and its comparison with nephrectomy are also presented.
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Affiliation(s)
| | | | - Yuichi Sugino
- Department of Radiology, Mie University School of Medicine
| | | | - Hajime Sakuma
- Department of Radiology, Mie University School of Medicine
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Konstantinidis C, Trilla E, Serres X, Montealegre C, Lorente D, Castellón R, Morote J. Association among the R.E.N.A.L. nephrometry score and clinical outcomes in patients with small renal masses treated with percutaneous contrast enhanced ultrasound radiofrequency ablation. Cent European J Urol 2019; 72:92-99. [PMID: 31482014 PMCID: PMC6715079 DOI: 10.5173/ceju.2019.1833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 03/05/2019] [Accepted: 05/28/2019] [Indexed: 12/24/2022] Open
Abstract
Introduction An association between the R.E.N.A.L. nephrometry score (RNS) and clinical outcomes in patients with a small renal mass (SRM) has been proposed. We analyzed clinical outcomes according to the RNS in patients with a SRM treated with percutaneous contrast enhanced ultrasound (CEUS) radiofrequency ablation (RFA). Material and methods Patients with a SRM, who underwent RFA between January 2005 and March 2015, were retrospectively identified. The association between RNS and clinical outcomes was evaluated using parametric and non-parametric analysis. Results We analyzed 163 SRMs in 149 consecutive patients. The mean age was 71.7 years. Mean follow-up time was 33.3 months ±20.6 (2-102). The mean RNS was 5.6 ±1.52 (4-11). A total of 121 (74.2%) cases were of low complexity and 42 (25.8%) were medium complexity. We identified 11 cases of tumor persistence (6.7%). The mean RNS was 5.58 in the cases with no persistence and 5.73 in the cases with persistence (p = 0.788). We identified 15 (9.2%) cases of recurrence. The mean RNS was 5.57 ±0.1 (4-11) in the cases without recurrence and 5.73 ±0.4 (4-9) in recurrence cases (p = 0.804). Of the 76 biopsy proven RCC cases, 8 (10.5%) cases of recurrence were observed, 5 in the low complexity group and 3 in the medium complexity group (p = 0.690). A total of 9 (5.5%) cases of complications were observed, with 5 (4.3%) in the low complexity group and 4 cases in the medium complexity group (p = 0.23). The mean length of stay was 1.5 days with a significant difference between low and medium complexity groups (1.3 vs. 2.1 days, p = 0.02). The mean difference between preoperative eGFR and estimated eGFRat 12 months was -3.08 mL / min ±13.3 (-49.4-34.1) and was significant (p = 0.008).However, this variation did not show significant differences between the low and medium complexity groups (p = 0.936). All-cause mortality was 11.7%, 14 cases (11.6%) in the low complexity group and 5 (11.9%) in the medium complexity group (p = 1.0). No cases of renal cell carcinoma (RCC) specific mortality were identified. Conclusions The RNS was not associated with tumor persistence, recurrence, cancer specific mortality, complications or renal function 12 months after the first treatment, showing significant difference only in length of hospital stay between low and medium complexity groups.
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Affiliation(s)
- Cristian Konstantinidis
- Department of Urology, Valld'Hebron University Hospital, Barcelona, Spain.,Universitat Autònoma de Barcelona, Spain
| | - Enrique Trilla
- Department of Urology, Valld'Hebron University Hospital, Barcelona, Spain.,Universitat Autònoma de Barcelona, Spain
| | - Xavier Serres
- Universitat Autònoma de Barcelona, Spain.,Department of Radiology, Valld'Hebron University Hospital, Barcelona, Spain
| | | | - David Lorente
- Department of Urology, Valld'Hebron University Hospital, Barcelona, Spain.,Universitat Autònoma de Barcelona, Spain
| | - Rafael Castellón
- Department of Radiology, Valld'Hebron University Hospital, Barcelona, Spain
| | - Juan Morote
- Department of Urology, Valld'Hebron University Hospital, Barcelona, Spain.,Universitat Autònoma de Barcelona, Spain
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Radiofrequency Ablation-Assisted Zero-Ischemia Robotic Laparoscopic Partial Nephrectomy: Oncologic and Functional Outcomes in 49 Patients. Adv Urol 2016; 2016:8045210. [PMID: 28044075 PMCID: PMC5156787 DOI: 10.1155/2016/8045210] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 11/01/2016] [Accepted: 11/03/2016] [Indexed: 01/20/2023] Open
Abstract
Introduction and Objectives. Robotic partial nephrectomy with peritumoral radiofrequency ablation (RFA-RPN) is a novel clampless technique. We describe oncologic and functional outcomes in a prospective cohort. Methods. From May, 2007, to December, 2009, 49 consecutive patients with renal masses <7 cm underwent RFA-RPN. During this period, only the RFA-RPN technique was utilized for all cases of partial nephrectomy. Pre- and postoperative data were analyzed and compared to 36 consecutive patients who underwent LPN. Results. In total, 49 tumors were treated in the RFA-RPN group and 36 tumors in the comparison group. Mean operative time was longer in the RFA-RPN group (370 min versus 293 min, p < 0.001). There were no significant differences in mean EBL (231 cc versus 250 cc, p = 0.42), transfusion rate (8.2% versus 11.1%, p = 0.7), or hospital stay (3.9 versus 4.4 days, p = 0.2). Two patients in the RFA-RPN (4.1%) and 1 (2.7%) patient in the comparison group had a positive surgical margin (p = 0.75). 17 (34.7%) patients had a postoperative urine leak in the RFA-RPN group versus 2 (5.6%) patients in the comparison group (p = 0.001). Mean follow-up was 54 months versus 68.4 months in the comparison group. There was no significant difference between the two groups regarding change in GFR (p = 0.67). There were 3 recurrences (6.1%) in the RFA-RPN group and 0 recurrences in the RPN group (p = 0.23). There were 3 deaths (6.1%) in the RFA-RPN group (one cancer specific) and 4 deaths (11.1%) in the RPN group (non-cancer specific) over the follow-up period (p = 0.44). Conclusions. Our data suggests that this technique is associated with a similar degree of renal preservation but higher rates of postoperative urine leak and possibly higher rates of recurrence.
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Raman JD, Jafri SM, Qi D. Kidney function outcomes following thermal ablation of small renal masses. World J Nephrol 2016; 5:283-287. [PMID: 27152264 PMCID: PMC4848151 DOI: 10.5527/wjn.v5.i3.283] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 02/13/2016] [Accepted: 03/23/2016] [Indexed: 02/06/2023] Open
Abstract
The diagnosis of small renal masses (SRMs) continues to increase likely attributable to widespread use of axial cross-sectional imaging. Many of these SRMs present in elderly patients with abnormal baseline renal function. Such patients are at risk for further decline following therapeutic intervention. Renal thermal ablation presents one approach for management of SRMs whereby tumors are treated in situ without need for global renal ischemia. These treatment characteristics contribute to favorable renal function outcomes following kidney tumor ablation particularly in patients with an anatomic or functional solitary renal unit.
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False-Positive Tumor Enhancement After Cryoablation of Renal Cell Carcinoma: A Prospective Study. AJR Am J Roentgenol 2016; 206:332-9. [DOI: 10.2214/ajr.15.14821] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Lay AH, Stewart J, Canvasser NE, Cadeddu JA, Gahan JC. Likelihood of Incomplete Kidney Tumor Ablation with Radio Frequency Energy: Degree of Enhancement Matters. J Urol 2016; 196:41-5. [PMID: 26826583 DOI: 10.1016/j.juro.2016.01.099] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2016] [Indexed: 11/17/2022]
Abstract
PURPOSE Larger size and clear cell histopathology are associated with worse outcomes for malignant renal tumors treated with radio frequency ablation. We hypothesize that greater tumor enhancement may be a risk factor for radio frequency ablation failure due to increased vascularity. MATERIALS AND METHODS A retrospective review of patients who underwent radio frequency ablation for renal tumors with contrast enhanced imaging available was performed. The change in Hounsfield units (HU) of the tumor from the noncontrast phase to the contrast enhanced arterial phase was calculated. Radio frequency ablation failure rates for biopsy confirmed malignant tumors were compared using the chi-squared test. Multivariate logistic analysis was performed to assess predictive variables for radio frequency ablation failure. Disease-free survival was calculated using Kaplan-Meier analysis. RESULTS A total of 99 patients with biopsy confirmed malignant renal tumors and contrast enhanced imaging were identified. The incomplete ablation rate was significantly lower for tumors with enhancement less than 60 vs 60 HU or greater (0.0% vs 14.6%, p=0.005). On multivariate logistic regression analysis tumor enhancement 60 HU or greater (OR 1.14, p=0.008) remained a significant predictor of incomplete initial ablation. The 5-year disease-free survival for size less than 3 cm was 100% vs 69.2% for size 3 cm or greater (p <0.01), while 5-year disease-free survival for HU change less than 60 was 100% vs 92.4% for HU change 60 or greater (p=0.24). CONCLUSIONS Biopsy confirmed malignant renal tumors, which exhibit a change in enhancement of 60 HU or greater, experience a higher rate of incomplete initial tumor ablation than tumors with enhancement less than 60 HU. Size 3 cm or greater portends worse 5-year disease-free survival after radio frequency ablation. The degree of enhancement should be considered when counseling patients before radio frequency ablation.
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Affiliation(s)
- Aaron H Lay
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jeremy Stewart
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Noah E Canvasser
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jeffrey A Cadeddu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jeffrey C Gahan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
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Cooper CJ, Teleb M, Dwivedi A, Rangel G, Sanchez LA, Laks S, Akle N, Nahleh Z. Comparative Outcome of Computed Tomography-guided Percutaneous Radiofrequency Ablation, Partial Nephrectomy or Radical Nephrectomy in the Treatment of Stage T1 Renal Cell Carcinoma. Rare Tumors 2015; 7:5583. [PMID: 25918603 PMCID: PMC4387349 DOI: 10.4081/rt.2015.5583] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 10/13/2014] [Accepted: 10/23/2014] [Indexed: 12/21/2022] Open
Abstract
Renal cell carcinoma (RCC) accounts for 3% of all cancers in adults. The indications for Radiofrequency Ablation (RFA) for renal carcinomas include T1a (tumor 4 cm or less, limited to the kidney), elderly patients, renal impairment, comorbidities, poor surgical candidate, and multiple bilateral renal masses. We retrospectively reviewed medical records, specifically investigating the indications, complications and outcomes of RFA and nephrectomy for treatment of RCC in a tertiary medical center with a predominantly Hispanic patient population. Forty-nine patients with RCC were evaluated. Nine patients had RFA, 9 had partial nephrectomy and 31 had radical nephrectomy. All patients among the 3 groups had stage T1N0M0 RCC at diagnosis. Tumor recurrence was observed in 2 (22%) patients that had RFA, one (11%) patient that had partial nephrectomy and no patients that had radical nephrectomy. One patient had recurrence of the tumor at the opposite kidney pole from the initial RFA site 4 years later. This particular patient did not have any tumor recurrence at the site of the initial RFA. A second RFA was performed on the recurrent tumor with no recurrence upon subsequent follow up visits. The second patient had recurrence of the RCC on 1 year follow that was discovered to be sarcomatoid RCC, which is an aggressive type with a poor prognosis. Our results support the clinical utility of RFA in patients with stage T1 RCC who are poor surgical candidates or those with reduced renal function. The clinical utility of RFA as an equally effective approach when compared to partial nephrectomy in patients with stage T1 RCC that meet strict indications for the procedure. The treatment choice should be individualized and based on the characteristics of the renal tumor such as size, location and histological type of RCC. We conclude that RFA presents a safe treatment choice for patients with RCC if long term follow up is maintained.
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Affiliation(s)
- Chad J Cooper
- Department of Internal Medicine, Texas Tech University Health Sciences Center of El Paso , TX, USA
| | - Mohamed Teleb
- Department of Internal Medicine, Texas Tech University Health Sciences Center of El Paso , TX, USA
| | - Alok Dwivedi
- Department of Biomedical Sciences, Division of Biostatistics and Epidemiology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center of El Paso , TX, USA
| | - Gabriela Rangel
- Department of Internal Medicine, Texas Tech University Health Sciences Center of El Paso , TX, USA
| | - Luis A Sanchez
- Department of Biomedical Sciences, Division of Biostatistics and Epidemiology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center of El Paso , TX, USA
| | - Shaked Laks
- Department of Radiology, Texas Tech University Health Sciences Center of El Paso , TX, USA
| | - Nassim Akle
- Department of Radiology, Texas Tech University Health Sciences Center of El Paso , TX, USA
| | - Zeina Nahleh
- Department of Internal Medicine, Texas Tech University Health Sciences Center of El Paso , TX, USA
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Wu R, Xu FH, Yao MH, Xie J, Hu B. Contrast-enhanced ultrasonography follow-up after radiofrequency ablation in normal rabbit kidney. Arch Med Sci 2013; 9:608-13. [PMID: 24049518 PMCID: PMC3776188 DOI: 10.5114/aoms.2013.37271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 10/14/2012] [Accepted: 11/21/2012] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION The aim of this study was to evaluate the diagnostic performance of SonoVue-enhanced ultrasonography in the follow-up of rabbit kidney lesions induced by percutaneous radiofrequency ablation. MATERIAL AND METHODS New Zealand rabbits (28) underwent percutaneous radiofrequency ablation (RFA) to generate renal lesions. Lesions were evaluated by conventional 2D ultrasound and contrast-enhanced ultrasonography (CEUS) at 1 day, 1 week, 1 month and 3 months after RFA, and the results were compared to gross pathology. RESULTS One day and 1 week after RFA, renal lesions were wedge-shaped in the gross dissection cross-sectional profiles. Conventional ultrasound could not indicate the extent of the lesions; however, CEUS could exactly delineate the lesion shape and size. At 1 and 3 months, lesions were observed as hyperechogenic areas on conventional ultrasound, and as small perfusion defects on CEUS. The differences in the lesion measurements obtained by CEUS and in pathological specimens were not statistically significant (p > 0.05). CONCLUSIONS The conclusion could be deduced from the study that SonoVue-enhanced ultrasonography was effective for the follow-up of normal rabbit kidney percutaneous radiofrequency ablation.
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Affiliation(s)
- Rong Wu
- Department of Ultrasound in Medicine, Shanghai tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Fan-hua Xu
- Department of Ultrasound in Medicine, the Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China
| | - Ming-hua Yao
- Department of Ultrasound in Medicine, Shanghai tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Juan Xie
- Department of Ultrasound in Medicine, Shanghai tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Bing Hu
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University affiliated Sixth People's Hospital, Shanghai, China
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Sommer CM, Lemm G, Hohenstein E, Stampfl U, Bellemann N, Teber D, Rassweiler J, Kauczor HU, Radeleff BA, Pereira PL. Bipolar versus multipolar radiofrequency (RF) ablation for the treatment of renal cell carcinoma: differences in technical and clinical parameters. Int J Hyperthermia 2013; 29:21-9. [PMID: 23311376 DOI: 10.3109/02656736.2012.750015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE This study aimed to compare retrospectively bipolar RF ablation with multipolar RF ablation for the treatment of renal cell carcinoma. MATERIALS AND METHODS Between March 2009 and June 2012, 12 tumours (nine patients) treated with bipolar RF ablation (one applicator) and 14 tumours (11 patients) treated with multipolar RF ablation (two applicators) were compared systematically. Selection between bipolar RF ablation and multipolar RF ablation was operator choice considering tumour size. Study goals included differences in tumour and coagulation extent, and technical parameters (total RF energy delivery and RF ablation time per coagulation volume). RESULTS Tumour maximum diameter was significantly larger for multipolar RF ablation compared with bipolar RF ablation (27.0 mm versus 19.4 mm; p < 0.01). This difference is partially dependent on operator choice. Coagulation length, width and volume were significantly larger for multipolar RF ablation compared with bipolar RF ablation (35.0 mm versus 26.5 mm, 27.5 mm versus 23.0 mm and 14.3 cm(3) versus 8.1 cm(3); p < 0.01, p < 0.05 and p < 0.05, respectively). Coagulation circularity was not significantly different between both study groups (0.8 versus 0.8; not significant). Total RF energy delivery was significantly higher and RF ablation time per coagulation volume was significantly shorter for multipolar RF ablation compared with bipolar RF ablation (52.0 kJ versus 28.6 kJ and 2.4 min/cm(3) versus 4.1 min/cm(3); p < 0.05 and p < 0.05, respectively). CONCLUSIONS Multipolar RF ablation creates a significantly larger coagulation width, but identical coagulation shape, compared with bipolar RF ablation. Additionally, multipolar RF ablation coagulates faster according to the shorter RF ablation time per coagulation volume.
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Affiliation(s)
- Christof M Sommer
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany.
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Chen Y, Huang J, Xia L, Dong B, Chen W, Xue W, Liu D, Huang Y. Monitoring Laparoscopic Radiofrequency Renal Lesions in Real Time Using Contrast-Enhanced Ultrasonography: An Open-Label, Randomized, Comparative Pilot Trial. J Endourol 2013; 27:697-704. [PMID: 23442174 DOI: 10.1089/end.2012.0694] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Yonghui Chen
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jiwei Huang
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lei Xia
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Baijun Dong
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Chen
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Xue
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Dongming Liu
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yiran Huang
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Bhan SN, Pautler SE, Shayegan B, Voss MD, Goeree RA, You JJ. Active surveillance, radiofrequency ablation, or cryoablation for the nonsurgical management of a small renal mass: a cost-utility analysis. Ann Surg Oncol 2013; 20:3675-84. [PMID: 23720071 DOI: 10.1245/s10434-013-3028-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients with a cortical small (≤4 cm) renal mass often are not candidates for or choose not to undergo surgery. The optimal management strategy for such patients is unclear. METHODS A decision-analytic Markov model was developed from the perspective of a third party payer to compare the quality-adjusted life expectancy and lifetime costs for 67-year-old patients with a small renal mass undergoing premanagement decision biopsy, immediate percutaneous radiofrequency ablation or percutaneous cryoablation (without premanagement biopsy), or active surveillance with serial imaging and subsequent ablation if needed. RESULTS The dominant strategy (most effective and least costly) was active surveillance with subsequent cryoablation if needed. On a quality-adjusted and discounted basis, immediate cryoablation resulted in a similar life expectancy (3 days fewer) but cost $3,010 more. This result was sensitive to the relative rate of progression to metastatic disease. Strategies that employed radiofrequency ablation had decreased quality-adjusted life expectancies (82-87 days fewer than the dominant strategy) and higher costs ($3,231-$6,398 more). CONCLUSIONS Active surveillance with delayed percutaneous cryoablation, if needed, may be a safe and cost-effective alternative to immediate cryoablation. The uncertainty in the relative long-term rate of progression to metastatic disease in patients managed with active surveillance versus immediate cryoablation needs to be weighed against the higher cost of immediate cryoablation. A randomized trial is needed directly to evaluate the nonsurgical management of patients with a small renal mass, and could be limited to the most promising strategies identified in this analysis.
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Affiliation(s)
- Sasha N Bhan
- Department of Radiology, McMaster University, Hamilton, ON, Canada.
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Zhao X, Wang W, Zhang S, Liu J, Zhang F, Ji C, Li X, Gan W, Zhang G, Guo H. Improved outcome of percutaneous radiofrequency ablation in renal cell carcinoma: a retrospective study of intraoperative contrast-enhanced ultrasonography in 73 patients. Abdom Radiol (NY) 2012; 37:885-91. [PMID: 22131041 DOI: 10.1007/s00261-011-9828-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To evaluate the impact of contrast-enhanced ultrasonography (CEUS) during percutaneous radiofrequency ablation (PRFA) procedure in renal cell carcinoma (RCC). METHODS From January 2008 to July 2010, 73 patients with sporadic unilateral RCC were enrolled to our study (57 men and 16 women, age range: 37-78 years, mean age 57.9 years). The diameter of the tumor was 1.7-5.8, 3.4 cm on average. The patients were divided into two groups depending on the intraoperative ultrasonography type: CEUS group and conventional ultrasound group. Patients in CEUS group received CEUS before insertion of the electrode, and the second CEUS was performed right after the initial ablation to dynamically evaluate the images. If there was highly suspicious residue, additional ablation and repeated CEUS were applied. Patients in the conventional ultrasound group received PRFA guided by gray-scale ultrasound. All of these patients received contrast-enhanced computed tomography (CT) examination 7 days after the procedure (patients in CEUS group received CEUS conducted with each CT scan), with subsequent CT and CEUS assessment at 3, 6, and every 6 months thereafter. RESULTS The mean follow-up period was 22 months (range: 12-42 months). All tumors were biopsied before RFA. The local tumor control rate was 94.6% (35/37) in the CEUS group and 86.1% (31/36) in the conventional ultrasound group (P < 0.05); the cancer-specific survival rate and the overall survival rate were 100%. The post-RFA (12 months) mean GFR levels were 84.7 ± 27.5 mL/min/1.73 m(2) (P > 0.05, compared with pre-GFR: 86.4 ± 26.2 mL/min/1.73 m(2)) in the CEUS group and 81.9 ± 22.8 mL/min/1.73 m(2) (P > 0.05, compared with pre-GFR: 83.5 ± 23.7 mL/min/1.73 m(2)) in the conventional ultrasound group. CONCLUSION Intraoperative CEUS can "real-time" monitor the ablated area during PRFA procedure. This technique can help to achieve a higher success rate compared with conventional ultrasound. No impact of intraoperative CEUS has been found on GFR level.
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CT-guided Bipolar and Multipolar Radiofrequency Ablation (RF Ablation) of Renal Cell Carcinoma: Specific Technical Aspects and Clinical Results. Cardiovasc Intervent Radiol 2012; 36:731-7. [DOI: 10.1007/s00270-012-0468-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 07/29/2012] [Indexed: 12/16/2022]
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16
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Lian H, Guo H, Zhang G, Yang R, Gan W, Li X, Ji C, Liu J. Single-center Comparison of Complications in Laparoscopic and Percutaneous Radiofrequency Ablation With Ultrasound Guidance for Renal Tumors. Urology 2012; 80:119-24. [DOI: 10.1016/j.urology.2012.01.085] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 01/15/2012] [Accepted: 01/27/2012] [Indexed: 01/20/2023]
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17
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Lane BR, Whelan CM. The Influence of Surgical Approach to the Renal Mass on Renal Function. Urol Clin North Am 2012; 39:191-8, vi. [DOI: 10.1016/j.ucl.2012.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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18
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Zhang S, Zhao X, Ji C, Liu G, Li X, Zhang G, Gan W, Guo H. Radiofrequency ablation of synchronous bilateral renal cell carcinoma. Int J Urol 2011; 19:241-7. [DOI: 10.1111/j.1442-2042.2011.02918.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tremp M, Hefermehl L, Largo R, Knönagel H, Sulser T, Eberli D. Electrosurgery in urology: recent advances. Expert Rev Med Devices 2011; 8:597-605. [PMID: 22026625 DOI: 10.1586/erd.11.26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Inadequate hemostasis is one of the most important causes of morbidity and mortality following urological surgery. Despite the long-term usage of coagulation, there is an ongoing development of new devices, including bipolar transurethral resection of the prostate or new vessel-sealing devices. A thorough understanding of the advantages and disadvantages of these new instruments can improve the operative experience for both the urologist and patient. The optimal coagulation system should be small, efficient, easy to handle and with low heat spread. In this article, we analyze different electrothermal coagulation systems and modern tissue-sealing devices in urological applications with the aim to substantiate the advantages and disadvantages of each technique in terms of efficacy and safety.
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Affiliation(s)
- Mathias Tremp
- Department of Urology, University Hospital Zurich, Frauenklinikstr. 10, CH-8091 Zurich, Switzerland
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Application of contrast-enhanced ultrasonography after radiofrequency ablation for renal cell carcinoma: is it sufficient for assessment of therapeutic response? ACTA ACUST UNITED AC 2011; 36:342-7. [PMID: 21107560 DOI: 10.1007/s00261-010-9665-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To assess the efficacy of contrast-enhanced ultrasonography (CEUS) with Sonovue in the evaluation of therapeutic response to radiofrequency ablation (RFA) of renal cell carcinoma (RCC). MATERIALS AND METHODS In a recent 3 years, 63 patients (mean age, 60 years; range 26-81 years) with 64 RCCs were treated by RFA. The lesions had a diameter between 1.8 and 9.8 cm (average diameter, 3.1 cm). The indications for RFA treatment included chronic renal insufficiency (n = 10), presence of solitary kidney (n =3), bilateral renal carcinoma (BRCC) (n =2), advanced age (n =12), significant medical comorbidity (n =29) or refusal of conventional therapy (n =7). Tumors were treated by laparoscopy-assisted (n =41), open surgical (n =18) or percutaneous US guidance (n =4). Follow-up CEUS and contrast-enhanced CT were performed 1 month after treatment to assess the necrotic area. Technical success was defined as elimination of areas that enhanced at imaging within the entire tumor. RESULTS On the 1-month CEUS and CT imaging after RFA, 62 of 64 tumors (96.9%) were successfully ablated with one session, and residual tumors were found in two RCCs. One of the two tumors was subjected to additional RFA treatment. We could not obtain a complete ablation in the other tumor of a patient with solitary kidney. The diagnostic concordance between the CEUS and 1-month follow-up CT was 100%. Sixty-one patients survived in the follow-up phase which ranged from 2 to 34 months. One patient with solitary kidney died of systemic disease progression and one patient was lost to follow-up. Of the 61 tumors without residual on both CT and CEUS after RFA, four had suspicious findings of recurrence on follow-up CEUS, and two of them were confirmed by subsequent CT examination. With CT as the reference imaging procedure in the assessment of renal tumor ablation, the sensitivity, specificity, positive predictive value, and negative predictive value of CEUS for detecting recurrence during follow-up were 100%, 96.6%, 50%, and 100%. CONCLUSION Despite its limitation of false-positive value, CEUS is potentially effective in assessing the therapeutic response to RFA of RCC.
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Duffey BG, Kyle Anderson J. Current and future technology for minimally invasive ablation of renal cell carcinoma. Indian J Urol 2011; 26:410-7. [PMID: 21116364 PMCID: PMC2978444 DOI: 10.4103/0970-1591.70584] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose of Review: To provide an overview of the technologic advancements in the field of ablative therapy, focusing on the treatment of renal neoplasms. Materials and Methods: A MEDLINE search was performed using each specific ablative technique name as the search term. Articles written in the English language were selected for review. In cases of multiple reports by a single institution, the most recent report was utilized. Pertinent articles specific to the technologic advancement in ablative therapy were selected for review. Recent Findings: Intermediate-term oncologic outcomes of radiofrequency ablation (RFA) and cryoablation (CA) for the treatment of small renal masses are encouraging. For thermal therapies, molecular adjuvants to enhance cellular kill and local control have been developed. Improvements in microwave technology have allowed for reductions in antenna size and increases in ablation size. Laparoscopic high-intensity focused ultrasound (HIFU) probes have been developed to overcome the limitations of transcutaneous energy delivery, but HIFU remains experimental for the treatment of renal lesions. Irreversible electroporation (IRE), a novel nonthermal ablative technique, is currently undergoing clinical investigation in human subjects. Histotripsy causes mechanical destruction of targeted tissue and shows promise in treating renal and prostate pathology. Summary: Ablative techniques are commonly utilized in the primary treatment of urologic malignancies. The purpose of this review is to discuss technologic advances in ablative therapies with emphasis on the treatment of renal masses. RFA and CA show acceptable intermediate-term efficacy and technical refinement continues. Emerging technologies, including microwave thermotherapy, IRE, HIFU and histotripsy, are described with emphasis on the mechanism of cellular kill, energy delivery, and stage in clinical development.
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Abstract
The increase in detection of small (≤ 4 cm) renal cortical neoplasms has made nephron-sparing surgery the new standard of care for T1a renal lesions. Advances in minimally invasive surgery have improved the surgical approach to these lesions to include laparoscopic partial nephrectomy and renal ablative therapies. In this review, we discuss the indications, outcomes, and potential complications of the commonly used ablative modalities in urologic practice. We will expand on renal cryoablation and review the mechanism of action, surgical approaches, and evidence based medicine using this modality.
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Affiliation(s)
- Adam C Mues
- Columbia University, Department of Urology, 161 Fort Washington Avenue, Herbert Irving Pavilion, 11th Floor, New York, NY 10032, USA
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23
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Graversen JA, Mues AC, Landman J. Laparoscopic Ablation of Renal Neoplasms. J Endourol 2011; 25:187-94. [DOI: 10.1089/end.2010.0598] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Adam C. Mues
- Department of Urology, Columbia University, New York, New York
| | - Jaime Landman
- Department of Urology, University of California, Irvine, Orange, California
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Ji C, Li X, Zhang S, Gan W, Zhang G, Zeng L, Yan X, Liu T, Lian H, Guo H. Laparoscopic radiofrequency ablation of renal tumors: 32-month mean follow-up results of 106 patients. Urology 2011; 77:798-802. [PMID: 21256566 DOI: 10.1016/j.urology.2010.10.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Revised: 10/08/2010] [Accepted: 10/13/2010] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To report our experience of laparoscopic radiofrequency ablation (RFA) on patients with renal tumors. RFA has been increasingly applied in the management of small renal tumors. However, it was performed mostly via percutaneous approach, with limited cases and a short follow-up period. METHODS From February 2006 to March 2008, laparoscopic RFA was performed on 106 renal tumors (size range: 0.9-5.5 cm) in 106 selected patients (74 men and 32 women, age range: 25-81 years). Initial contrast-enhanced computed tomography (CT) examination was performed seven days after the procedure, with subsequent CT assessment at three months, six months, and every six months thereafter. Serum creatinine measurement was conducted along with each time CT examination. RESULTS The mean follow-up period was 32 months (range: 12-48). All 106 tumors were biopsied before RFA, of which 90 were diagnosed as renal cell carcinoma (RCC) (84.90%). There was one incomplete ablation. One case with radiographic local recurrence was then proved by pathologic analysis of the nephrectomy specimen to have no cancer cells. The local tumor control rate was 98.1% (104/106). Of the 90 RCC cases, the disease-free survival rate was 97.8% (88/90); both the cancer-specific and the overall survival rate were 100%. No death or renal failure after the procedure has yet been found. CONCLUSIONS Our results showed that the laparoscopic RFA on small renal mass was safe, with outcomes of patients comparable with those by partial nephrectomy and percutaneous RFA. Further research and a longer follow-up period are needed to confirm our results.
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Affiliation(s)
- Changwei Ji
- Drum Tower Hospital of Nanjing University Medical School, Department of Urology, Nanjing, China
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Nahirnyak VM, Moros EG, Novák P, Suzanne Klimberg V, Shafirstein G. Doppler signals observed during high temperature thermal ablation are the result of boiling. Int J Hyperthermia 2011; 26:586-93. [PMID: 20569109 DOI: 10.3109/02656731003801469] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To elucidate the causation mechanism of Spectral Doppler ultrasound signals (DUS) observed during high temperature thermal ablation and evaluate their potential for image-guidance. METHODS Sixteen ex vivo ablations were performed in fresh turkey breast muscle, eight with radiofrequency ablation (RFA) devices, and eight with a conductive interstitial thermal therapy (CITT) device. Temperature changes in the ablation zone were measured with thermocouples located at 1 to 10 mm away from the ablation probes. Concomitantly, DUS were recorded using a standard diagnostic ultrasound scanner. Retrospectively, sustained observations of DUS were correlated with measured temperatures. Sustained DUS was arbitrarily defined as the Doppler signals lasting more than 10 s as observed in the diagnostic ultrasound videos captured from the scanner. RESULTS For RFA experiments, minimum average temperature (T1 +/- SD) at which sustained DUS were observed was 97.2 +/- 7.3 degrees C, while the maximum average temperature (T2 +/- SD) at which DUS were not seen was 74.3 +/- 9.1 degrees C. For CITT ablation, T1 and T2 were 95.7 +/- 5.9 degrees C and 91.6 +/- 7.2 degrees C, respectively. It was also observed, especially during CITT ablation, that temperatures remained relatively constant during Doppler activity. CONCLUSIONS The value of T1 was near the standard boiling point of water (99.61 degrees C) while T2 was below it. Together, T1 and T2 support the conclusion that DUS during high temperature thermal ablation are the result of boiling (phase change). This conclusion is also supported by the nearly constant temperature histories maintained at locations from which DUS emanated.
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Affiliation(s)
- Volodymyr M Nahirnyak
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA
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26
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Thumar AB, Trabulsi EJ, Lallas CD, Brown DB. Thermal ablation of renal cell carcinoma: triage, treatment, and follow-up. J Vasc Interv Radiol 2010; 21:S233-41. [PMID: 20656233 DOI: 10.1016/j.jvir.2010.01.050] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Revised: 01/06/2010] [Accepted: 01/19/2010] [Indexed: 11/19/2022] Open
Abstract
The incidence of renal cell carcinoma (RCC) is increasing. With the increasing emphasis on minimally invasive nephron-sparing surgery, thermal ablation is playing a larger role in the management of patients with this disease. This review outlines imaging management, intraoperative and percutaneous ablation, and postprocedural follow-up of RCC.
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Affiliation(s)
- Adeep B Thumar
- Department of Urology, Thomas Jefferson University, 132 South 10th St, Suite 766 Main Building, Philadelphia, PA 19107, USA
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27
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Pedro RN, Thekke-Adiyat T, Goel R, Shenoi M, Slaton J, Schmechel S, Bischof J, Anderson JK. Use of Tumor Necrosis Factor–alpha-coated Gold Nanoparticles to Enhance Radiofrequency Ablation in a Translational Model of Renal Tumors. Urology 2010; 76:494-8. [DOI: 10.1016/j.urology.2010.01.085] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2009] [Revised: 11/27/2009] [Accepted: 01/15/2010] [Indexed: 11/29/2022]
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Imaging-guided percutaneous radiofrequency ablation of retroperitoneal metastatic disease in patients with gynecologic malignancies: clinical experience with eight patients. AJR Am J Roentgenol 2010; 194:1635-8. [PMID: 20489107 DOI: 10.2214/ajr.09.3561] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the efficacy of imaging-guided percutaneous radiofrequency ablation to treat metastatic retroperitoneal disease in patients with gynecologic malignancies. MATERIALS AND METHODS Patients with retroperitoneal metastatic disease due to gynecologic malignancies were evaluated for imaging-guided percutaneous radiofrequency ablation in this study. Efficacy of treatment was assessed by post-radiofrequency ablation activity on PET/CT scans. RESULTS Eight patients were considered for imaging-guided percutaneous radiofrequency ablation of retroperitoneal metastatic disease. Radiofrequency ablation was successfully completed in five patients with six metastatic tumors. All procedures were performed with the use of hydrodissection as an adjunct maneuver to displace adjacent structures. All patients showed absence of FDG activity on post-radiofrequency ablation PET/CT scans. Three (60%) of the five patients showed absence of FDG activity of the treated disease at 23.5 months after radiofrequency ablation. CONCLUSION Imaging-guided percutaneous radiofrequency ablation may be considered as an alternative to currently available therapies to treat recurrent metastatic disease due to endometrial carcinoma.
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Ablación por radiofrecuencia de tumores renales. Aspectos prácticos y resultados. RADIOLOGIA 2010; 52:228-33. [DOI: 10.1016/j.rx.2010.01.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Revised: 01/16/2010] [Accepted: 01/18/2010] [Indexed: 11/20/2022]
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Wu SD, Viprakasit DP, Cashy J, Smith ND, Perry KT, Nadler RB. Radiofrequency Ablation–Assisted Robotic Laparoscopic Partial Nephrectomy Without Renal Hilar Vessel Clamping Versus Laparoscopic Partial Nephrectomy: A Comparison of Perioperative Outcomes. J Endourol 2010; 24:385-91. [DOI: 10.1089/end.2009.0199] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Simon D. Wu
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Davis P. Viprakasit
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - John Cashy
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Norm D. Smith
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kent T. Perry
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Robert B. Nadler
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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32
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Mues AC, Landman J. Image-guided Percutaneous Ablation of Renal Tumors: Outcomes, Technique, and Application in Urologic Practice. Curr Urol Rep 2010; 11:8-14. [DOI: 10.1007/s11934-009-0084-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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33
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Zurera L, López D, Canis M, García-Revillo J, Campos P, Robles R, Molina G. Radiofrequency ablation of renal tumors: Practical aspects and results. RADIOLOGIA 2010. [DOI: 10.1016/s2173-5107(10)70015-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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34
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