Renal Ablation

Abstract

The incidence of kidney cancer is increasing steadily in the last three decades, with an estimated 60,920 new cases diagnosed in the United States in 2011. The majority of these tumors are small (≤4 cm), organ-confined, and detected incidentally at cross-sectional imaging. The current standard of care for clinically localized renal-cell carcinoma (RCC) is surgical, preferably with nephron-sparing surgery (NSS) because of the reported excellent oncologic outcome and overall survival (OS). Image-guided ablative techniques, mainly radiofrequency ablation (RFA) and cryoablation, are being used with increased frequency and excellent results in the management of small renal tumors.

• The ideal renal tumor for the percutaneous approach is small (<3 cm), partially exophytic, and posteriorly located in a patient who cannot tolerate a partial nephrectomy.

• Percutaneous RFA is a faster and less-expensive procedure than percutaneous cryoablation. Cryoablation is potentially more effective in central and larger lesions.

• Hydrodissection and pyeloperfusion techniques could prevent injuries to the adjacent organs and the collecting system.

• Close follow-up is required, with low threshold for re-intervention.