Comparison of postoperative pain, convalescence, and patient satisfaction after laparoscopic and percutaneous ablation of small renal masses

PURPOSE: To compare the convalescence and patient satisfaction between laparoscopic and percutaneous ablation for management of small renal masses. METHODS: We performed a telephone survey comparing convalescence and operative satisfaction of patients who underwent laparoscopic and percutaneous ablation between October 2000 and June 2006 at our institution. A retrospective chart review was performed to compare perioperative and postoperative convalescence parameters. RESULTS: A total of 93 patients underwent ablation of 103 small renal masses at our institution. Laparoscopic cryoablation was performed in 58 patients, percutaneous cryoablation in 20, and percutaneous radiofrequency ablation in 15 patients. Mean patient age was 66 years (range 24-86 years), median ASA (American society of Anesthesiologists) score was 3, and mean body mass index (BMI) was 30 kg/mm(2). There was no significant difference in the mean age, BMI, and median ASA scores between the groups. The mean diameter of the treated mass was slightly larger in the laparoscopic ablation group (2.6 cm) compared with masses in the percutaneous cryoablation (2.2 cm, P=0.027) and percutaneous radiofrequency ablation (2.2 cm, P=0.042) groups. All procedures were performed under general anesthesia. Compared with laparoscopic cryoablation, percutaneous cryoablation was associated with fewer probes used per lesion (P<0.04), shorter mean anesthesia time (P=0.001), shorter mean hospital stay (P=0.007), early return to nonstrenuous activity (P=0.007), and shorter time to complete recovery (P = 0.05). Similarly, compared with laparoscopic cryoablation, percutaneous radiofrequency ablation was associated shorter mean anesthesia time (P<0.001), early return to nonstrenuous activity (P=0.009), early return to strenuous activity (P=0.007), early return to strenuous activity (P=0.04), and early return to work (P=0.05). There was no difference in the percent of patients who had a preablation biopsy, the median opioid analgesic requirement, and patient satisfaction measured on a 0 to 5 scale between various groups. CONCLUSION: Our study suggests that percutaneous ablation in carefully selected patients is associated with early convalescence compared with laparoscopic ablation.     

腹腔镜辅助射频消融与经皮射频消融治疗原发性肝癌的临床对照研究

目的 回顾性研究腹腔镜辅助射频消融(laparoscopic radio frequency ablation,LRFA)与经皮射频消融( percutaneous radio frequency ablation,PRFA)治疗原发性肝癌(hepatocellular carcinoma,HCC)和特殊部位HCC的安全性和疗效.方法 回顾性分析525例HCC患者671个肿瘤结节,其中LRFA组78例106个肿瘤结节,PRFA组447例565个肿瘤结节.结果 (1)术后瘤体完全消融率:LRFA组为97.17％ (103/106),PRFA组为93.09％ (526/565).2组的瘤体完全消融率比较差异无统计学意义(x2=2.523,P =0.112).(2)1、3、5年总生存率:LRFA组为96.15％、55.12％和38.46％,PRFA组为93.73％、48.54％和31.54％.1、3、5年无瘤生存率:LRFA组为94.87％、43.58％和28.21％,PRFA组为91.65％、40.27％和25.95％.平均无瘤生存时间:LRFA组为22.25个月,PRFA组为21.53个月.2组1、3、5年总生存率比较差异无统计学意义(分别x2=0.699,1.151,1.447,P=0.403,0.283,0.229),无瘤生存率比较差异无统计学意义(分别x2=0.915,0.303,0.174;P =0.339,0.582,0.676).(3)严重并发症发生率LRFA组为0％ (0/78),PRFA组为1.34％( 6/447).(4) LRFA组复发率23.07％(18/78),复发时间为4～32个月;PRFA绢复发率34.89％(156/447),复发时间为3 ～38个月.2组复发率比较差异有统计学意义(x2=4.189,P=0.041).结论 LRFA的总体治疗效果等同于PRFA,但是LRFA的复发率和严重并发症的发生率较低,安全性较高.     

Radiofrequency ablation for the treatment of small renal masses: safety and oncologic efficacy

The successful introduction of radio frequency ablation (RFA) into various surgical fields has fueled the interest of the urological community to study its application in small renal masses (SRM). However, some controversies remain regarding its oncologic efficacy. In this paper, we review the complication rates and highlight local ablative success and long-term oncologic outcomes of recent, larger RFA series. Review of the recent literature (Medline from January 2003 through May 2011 with the terms ("radiofrequency ablation" OR "catheter ablation") AND ("renal cell carcinoma" OR "renal tumor" OR "renal mass" OR "renal cancer" OR "kidney cancer"). Twelve RFA studies including a minimum of 35 treated tumors, and representing 717 patients were identified and analyzed for local ablative success rates and complications. Reported complications were classified according to Dindo-Clavien. Another five studies representing 172 patients were identified to assess long-term oncologic outcomes. Final pathology revealed 82.3% biopsy-proven renal cell carcinomas (RCCs) in 8 of the 12 evaluable RFA studies. Local ablative success rates after a first RFA session ranged from 67% to 100%. However, accepting a 8.8% repeat ablation rate, final success rates were 89.7-100%, with 7 of 12 studies showing final ablative success in >95%. These results demonstrate RFA to achieve adequate local tumor control regardless of histology. Risk of complications was 13.2%. Of complications, 10% were minor (grade I or II), while only 3.2% were major complications (grade ≥III). Five papers were identified describing oncological outcome at a minimum follow-up of 53 months (range 53-61.2). Progression-free survival, cancer-specific survival and overall survival ranged from 79.9 to 93.8%, 98 to 100% and 58.3 to 85%, respectively. This literature review confirms that RFA can deliver durable local tumor control and excellent long-term oncological outcomes. However, in order to achieve this, a repeat ablation rate of 8.8% has to be accepted. Complication rates are low, with 10% grade I-II and only 3.2% grade >III. These observations render RFA an attractive alternative to surgery in an elderly or comorbid population.     

Percutaneous radio frequency ablation of renal masses: results at a 2-year mean followup

PURPOSE: We describe our experience with and results of percutaneous computerized tomography guided radio frequency ablation (RFA) for small (less than 4 cm) renal tumors at a 2-year mean followup. MATERIALS AND METHODS: A total of 49 patients (60 renal tumors) with a mean age of 63.9 years underwent percutaneous RFA. Indications for RFA were severe comorbidities or previous abdominal surgery precluding operative management, or hereditary conditions predisposing to multiple tumor recurrence. Persistent enhancement on initial followup imaging was considered incomplete treatment and all such patients underwent biopsy and were offered repeat RFA. Enhancement or enlargement on subsequent imaging was considered tumor recurrence and these patients were counseled regarding further therapy. RESULTS: Three patients (4 tumors) were excluded from evaluation due to death from unrelated causes or loss to followup. A total of 46 patients (56 tumors) were available for evaluation at a mean followup of 27.5 months (range 12 to 48). Six tumors were incompletely treated with the first RFA and successfully treated with a second session. Recurrences after successful initial treatment were seen in 3 of 46 patients. These recurrences developed 24, 25 and 31 months following RFA, respectively, and all occurred in patients with a central tumor of 3.0 cm or greater. Overall local control was achieved in 94.6% of tumors (53 of 56). CONCLUSIONS: RFA is an emerging alternative treatment modality for small renal tumors. Larger (greater than 3.0 cm) central tumors represent unique technical challenges, making these tumors more prone to recurrence. Long-term followup is needed to establish the oncological durability of this technique.     

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??Objective:To explore the feasibility and efficacy of percutaneous radio??frequency ablation through the guidance of computed tomography (CT) in the treatment of pulmonary neoplasm. Methods:Using CT to localize the tumor and determine the optimal approach,WE7568 ablation needle was inserted into the target lesion.Radiofrequency was applied via the electrode for 10 or 15 min at 75~95??. Results:Total 78 cases were received 80 times of radio??frequency ablations through the guidance of CT.Reduced size of the pulmonary neoplasm and reduced chest CT number by 30~37 were founded in most cases??77.4????.After the therapy,chest pain was alleviated in most cases.There was no severe complication and no case death. Conclusion:Percutaneous radio??frequency ablation through the guidance of CT is one of feasible and effective treatment in unoperateble or late stage solid lung cancer.     

Incomplete renal tumor destruction using radio frequency interstitial ablation

PURPOSE: We evaluate the efficacy of temperature based radio frequency ablation as a potential treatment modality for small (less than 3.5 cm.) renal tumors. MATERIALS AND METHODS: We treated 15 patients with a total of 20 tumors with radio frequency ablation through an open surgical approach immediately before partial nephrectomy. All tumors were biopsied before radio frequency ablation treatment. Tumors were heated to 90 to 110C for 6 to 16 minutes (mean 9.1). Tumor ablation was monitored by direct vision and ultrasound. Partial nephrectomy was performed in standard fashion. All specimens were stained with hematoxylin and eosin, and 5 specimens were stained for nicotinamide adenine dinucleotide (NADH) diaphorase activity. RESULTS: Tumors ranged from 1.5 to 3.5 cm. (mean 2.4) in greatest dimension. All 20 specimens had evidence of morphologically unchanged tumor and normal renal parenchyma on standard hematoxylin and eosin staining. Of the 5 specimens 4 stained positively for NADH in areas confirmed to be tumor in hematoxylin and eosin stained neighboring sections. There was 1 intraoperative renal pelvic thermal injury requiring pyeloplasty and 2 postoperative caliceal leaks requiring stent placement. CONCLUSIONS: In our series radio frequency therapy did not result in total tumor destruction when specimens were examined with hematoxylin and eosin or NADH staining. We believe that radio frequency interstitial tumor ablation of renal cell carcinoma without subsequent tissue resection should continue to be an investigational treatment modality for those who would otherwise undergo partial or radical nephrectomy.     

腔内微波和射频消融闭合大隐静脉主干的疗效及安全性对比分析

目的 探讨血管腔内微波消融（EMA）与射频消融（RFA）闭合大隐静脉主干的疗效和安全性差异。方法 收集2019年1—6月浙江省人民医院收治的316例大隐静脉功能不全患者的临床资料,并按照性别、年龄、病程、体重指数、身高、基础临床表现-病因-解剖-病理生理（CEAP）分级、大隐静脉主干直径的不同将患者筛选并分层配对为EMA组（n=157）和RFA组（n=159）。采用视觉模拟评分法（VAS）评价两组患者术后14 d的大隐静脉主干闭合段疼痛情况和皮肤瘀伤情况;术后第14天、6个月,所有患者均通过超声复查治疗段大隐静脉主干闭合情况。比较两组患者的术后并发症发生情况。结果 RFA组患者的术后VAS最高评分出现在术后第1天,EMA组患者的术后VAS最高评分出现在术后第3天。术后第1～10天,两组患者的VAS评分存在差异;与EMA组患者相比,RFA组患者的术后VAS评分更低。两组患者的皮肤瘀伤最高评分均出现在术后第4天;与EMA组患者相比,RFA组患者的皮肤瘀伤评分较低;术后第5～9天,两组患者的皮肤瘀伤评分差异较大。两组患者术后第14天、6个月的治疗段大隐静脉主干闭合率、术后并发症发生情况比较,...     

腹腔镜下射频消融治疗肝癌破裂出血的临床研究

目的:探讨腹腔镜下射频消融(LRFA)治疗原发性肝癌破裂出血的临床价值.方法:选取我院2007年7月-2011年7月确诊为肝癌破裂出血患者49例,其中男30例,女19例;年龄45 ～ 76岁,中位年龄(56.0±5.1)岁;LRFA治疗组(LRFA组)16例,手术切除治疗组(对照组)33例;统计分析两组患者性别、年龄、术前肝功能分级、术中肝门阻断时间、术中出血量、手术时间、止血成功率、术后并发症发生率、再出血率的差异、生存时间及生存率的差异,检验LRFA临床效果.结果:两组患者在性别、年龄、术前肝功能分级、肿瘤大小、数目方面的差异无统计学意义(P＞0.05);而两组患者在肝门阻断时间、术中出血量、手术时间、止血情况、再出血情况、术后并发症发生率及术后1年生存率差异有统计学意义(P＜0.05).结论:LRFA是肝癌破裂出血安全、可靠、有效的治疗手段,或可成为急诊肝癌破裂出血的首选方法.     

Retrograde renal cooling during radio frequency ablation to protect from renal collecting system injury

PURPOSE: We evaluated the protective effect of continuous retrograde irrigation of ice-cold saline on the renal collecting system during central parenchymal temperature based radio frequency ablation (RFA). MATERIALS AND METHODS: In 10 domestic pigs bilateral, centrally located renal parenchymal RFA lesions (intended 2 cm in diameter) were created that intentionally involved the collecting system. RFA probe placement was guided by fluoroscopy with retrograde collecting system opacification and simultaneous direct laparoscopic visualization. In 1 renal unit RFA was performed while infusing ice-cold saline through a previously placed ureteral access sheath and pigtail stent. RFA without renal cooling was performed in the contralateral renal unit. Kidneys were harvested at 7 days. The renal collecting system was inspected for injury by performing retrograde pyelograms and by histological examination of the collecting system adjacent to the ablation zone. The size of RFA lesions was measured. RESULTS: In retrograde cooling procedures the temperature of saline irrigant was -1.0C and the mean temperature of the effluent was 13C. One of 10 cooled renal units demonstrated contrast material extravasation from the collecting system involved by the ablation zone compared with 7 of 10 noncooled renal units (p = 0.025). Lesion size was comparable between cooled kidneys and controls (2.67 and 2.72 cm, respectively, p = 0.629). CONCLUSIONS: Retrograde renal cooling helps protect the renal collecting system from injury during RFA without a decrease in expected lesion size. Clinically retrograde renal cooling may decrease the risk of collecting system injury and subsequent complications during RFA.     

Percutaneous radio frequency ablation of small renal tumors: initial results.

PURPOSE: Thermal tissue ablation with radio frequency energy is an experimental treatment of renal tumor. We report early results of an ongoing trial of percutaneous radio frequency ablation for small renal tumors. MATERIALS AND METHODS: Patients with percutaneously accessible renal tumors were evaluated for radio frequency ablation. Tumors were solid on computerized tomography (CT), 3 cm. or less in diameter and enlarging during at least 1 year. Ablation was performed at the Interventional Radiology suite under ultrasound and/or CT guidance. A 50 W., 460 kHz. electrosurgical generator delivered radio frequency energy via a percutaneously placed 15 gauge coaxial probe. At least 2, 10 to 12-minute ablation cycles were applied to each lesion. Patients were observed overnight before discharge from hospital and reevaluated 2 months later. RESULTS: A total of 24 ablations were performed in 21 patients with renal tumor, including solid von Hippel-Lindau clear cell tumor in 19 and hereditary papillary renal cancer 2. Most (22 of 24) procedures were performed with patients under conscious sedation. At 2 months postoperatively mean tumor diameter plus or minus standard deviation decreased from 2.4 +/- 0.4 to 2.0 +/- 0.5 cm. (p = 0.001), and a majority of tumors (19 of 24, 79%) ceased to be enhanced on contrast CT. Mean serum creatinine plus or minus standard deviation was unchanged during this interval (1.0 +/- 0.2 mg./dl.). No major and 4 minor complications were encountered, including 2 episodes each of transient psoas pain and flank skin numbness. CONCLUSIONS: Percutaneous radio frequency ablation of small renal tumor is well tolerated and minimally invasive. It will remain experimental until procedural and imaging parameters that correlate with tumor destruction are validated.     

经皮射频治疗肝海绵状血管瘤的疗效与安全性分析

目的评价经皮射频(percutaneous radiofrequency ablation, PRFA)微创治疗肝脏海绵状血管瘤(hepatic cavernous hemangiomas,HCHs)的有效性和安全性. 方法应用RF-2000射频仪和10电极LeVeen射频针在超声引导下施行PRFA治疗HCHs 26例39个病灶直径2.5～11.0 cm,其中直径＞3.0 cm者予分层多点或多次叠合消融.局部麻醉,配合全身镇痛处理. 结果 26例均成功实施PRFA.反应期2～5天,包括局部疼痛不适、发热、ALT升高等,无胆漏、出血等并发症.23例随访1～5年,平均2年8个月,经一次治疗完全缓解(CR)22例,部分缓解(PR)1例,缓解率(CR PR)100%;HCHs直径平均缩小68.8%(41.2%～81.5%). 结论在掌握好适应证和操作技巧的前提下,PRFA可发挥微创、安全、有效之优势,可作为治疗HCHs的一种理想选择方法.     

Diversity treatment and efficacy of ultrasound-guided percutaneous and laparoscopic radiofrequency ablation for hepatic hemangioma

目的 探讨超声引导下经皮肝穿及腹腔镜下射频消融(RFA)治疗肝脏血管瘤的疗效和差异化应用价值.方法 72例共90个病灶分别在超声引导下经皮肝穿及腹腔镜下RFA治疗.结果 超声引导下经皮肝穿RFA 54例,平均治疗时间为48.5min;其中39例转氨酶升高,1例术后出血;无胆漏、空腔脏器穿孔等并发症.腹腔镜下射频18例,平均治疗时间为56.5min;全部病例转氨酶升高;其中1例术后出现急性肾衰竭,血液透析痊愈.54例获得随访,随访时间6～48个月.其中,病灶完全消失32例,缩小大于50％者15例,缩小小于50％者6例,缩小后再复发1例.结论 RFA治疗肝脏血管瘤是一种安全有效的微创手段,差异化选择RFA治疗途径可有效减少术后并发症.