Top

BMC Urology

Published in:

Open Access 01-12-2018 | Research article

Perioperative outcomes of zero ischemia radiofrequency ablation-assisted tumor enucleation for renal cell carcinoma: results of 182 patients

Authors: Chengwei Zhang, Xiaozhi Zhao, Suhan Guo, Changwei Ji, Wei Wang, Hongqian Guo

Published in: BMC Urology | Issue 1/2018

Abstract

Background

To evaluate the perioperative outcomes of zero ischemia radiofrequency ablation-assisted tumor enucleation.

Methods

Patients undergoing zero ischemia radiofrequency ablation-assisted tumor enucleation were retrospectively identified from July 2008 to March 2013. The tumor was enucleated after RFA treatment. R.E.N.A.L., PADUA and centrality index (C-index) score systems were used to assess each tumor case. We analyzed the correlation of perioperative outcomes with these scores. Postoperative complications were graded with Clavien-Dindo system. Multivariate logistic regression analyses were used to assess risk of complications.

Results

Among 182 patients assessed, median tumor size, estimated blood loss, hospital stay and operative time were 3.2 cm (IQR 2.8–3.4), 80 ml (IQR 50–120), 7 days (IQR 6–8) and 100 min (IQR 90–120), respectively. All three scoring systems were strongly correlated with estimated blood loss, hospital stay and operative time. We found 3 (1.6%) intraoperative and 23 (12.6%, 13 [7.1%] Grade 1 and 10 [5.5%] Grade 2 & 3a) postoperative complications. The median follow-up was 55.5 months (IQR 45–70). Additionally, the complexities of R.E.N.A.L., PADUA and C-index scores were significantly correlated with complication grades (P < 0.001; P < 0.001; P < 0.001; respectively). As the representative, R.E.N.A.L. score was an independent predictive factor for postoperative complications and patients with a high complexity had an over 24-fold higher risk compared to those with a low complexity (OR 24.360, 95% CI 4.412–134.493, P < 0.001).

Conclusions

Zero ischemia radiofrequency ablation-assisted tumor enucleation is considered an effective nephron-sparing treatment. Scoring systems could be useful for predicting perioperative outcomes of radiofrequency ablation-assisted tumor enucleation.

Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin. 2014;64(1):9–29.CrossRefPubMed

Uzzo RG, Novick AC. Nephron sparing surgery for renal tumors: indications, techniques and outcomes. J Urol. 2001;166(1):6–18.CrossRefPubMed

Zagoria RJ, Pettus JA, Rogers M, Werle DM, Childs D, Leyendecker JR. Long-term outcomes after percutaneous radiofrequency ablation for renal cell carcinoma. Urology. 2011;77(6):1393–7.CrossRefPubMed

Ljungberg B, Cowan NC, Hanbury DC, Hora M, Kuczyk MA, Merseburger AS, Patard JJ, Mulders PF, Sinescu IC, European Association of Urology Guideline G. EAU guidelines on renal cell carcinoma: the 2010 update. Eur Urol. 2010;58(3):398–406.CrossRefPubMed

Carini M, Minervini A, Masieri L, Lapini A, Serni S. Simple enucleation for the treatment of PT1a renal cell carcinoma: our 20-year experience. Eur Urol. 2006;50(6):1263–8. discussion 1269-1271CrossRefPubMed

Minervini A, Serni S, Tuccio A, Siena G, Vittori G, Masieri L, Giancane S, Lanciotti M, Khorrami S, Lapini A, et al. Simple enucleation versus radical nephrectomy in the treatment of pT1a and pT1b renal cell carcinoma. Ann Surg Oncol. 2012;19(2):694–700.CrossRefPubMed

Triadafilopoulos G. The great beyond: radiofrequency ablation for hemostasis. Endoscopy. 2014;46(11):925–6.CrossRefPubMed

Jacomides L, Ogan K, Watumull L, Cadeddu JA. Laparoscopic application of radio frequency energy enables in situ renal tumor ablation and partial nephrectomy. J Urol. 2003;169(1):49–53. discussion 53CrossRefPubMed

Zhao X, Zhang S, Liu G, Ji C, Wang W, Chang X, Chen J, Li X, Gan W, Zhang G, et al. Zero ischemia laparoscopic radio frequency ablation assisted enucleation of renal cell carcinoma: experience with 42 patients. J Urol. 2012;188(4):1095–101.CrossRefPubMed

10.

Kutikov A, Uzzo RG. The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol. 2009;182(3):844–53.CrossRefPubMed

11.

Ficarra V, Novara G, Secco S, Macchi V, Porzionato A, De Caro R, Artibani W. Preoperative aspects and dimensions used for an anatomical (PADUA) classification of renal tumours in patients who are candidates for nephron-sparing surgery. Eur Urol. 2009;56(5):786–93.CrossRefPubMed

12.

Simmons MN, Ching CB, Samplaski MK, Park CH, Gill IS. Kidney tumor location measurement using the C index method. J Urol. 2010;183(5):1708–13.CrossRefPubMed

13.

Samplaski MK, Hernandez A, Gill IS, Simmons MN. C-index is associated with functional outcomes after laparoscopic partial nephrectomy. J Urol. 2010;184(6):2259–63.CrossRefPubMed

14.

Kwon T, Jeong IG, Ryu J, Lee C, Lee C, You D, Kim CS. Renal function is associated with Nephrometry score after partial nephrectomy: a study using diethylene Triamine Penta-acetic acid (DTPA) renal scanning. Ann Surg Oncol. 2015;22(Suppl 3):1594–600.

15.

Satasivam P, Sengupta S, Rajarubendra N, Chia PH, Munshey A, Bolton D. Renal lesions with low R.E.N.A.L nephrometry score are associated with more indolent renal cell carcinomas (RCCs) or benign histology: findings in an Australian cohort. BJU Int. 2012;109(Suppl 3):44–7.CrossRefPubMed

16.

Spaliviero M, Poon BY, Aras O, Di Paolo PL, Guglielmetti GB, Coleman CZ, Karlo CA, Bernstein ML, Sjoberg DD, Russo P, et al. Interobserver variability of R.E.N.A.L., PADUA, and centrality index nephrometry score systems. World J Urol. 2015;33(6):853–8.CrossRefPubMed

17.

Bylund JR, Gayheart D, Fleming T, Venkatesh R, Preston DM, Strup SE, Crispen PL. Association of tumor size, location, R.E.N.A.L., PADUA and centrality index score with perioperative outcomes and postoperative renal function. J Urol. 2012;188(5):1684–9.CrossRefPubMed

18.

Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of diet in renal disease study group. Ann Intern Med. 1999;130(6):461–70.CrossRefPubMed

19.

Minervini A, Vittori G, Lapini A, Tuccio A, Siena G, Serni S, Carini M. Morbidity of tumour enucleation for renal cell carcinoma (RCC): results of a single-Centre prospective study. BJU Int. 2012;109(3):372–7. discussion 378CrossRefPubMed

20.

Minervini A, Ficarra V, Rocco F, Antonelli A, Bertini R, Carmignani G, Cosciani Cunico S, Fontana D, Longo N, Martorana G, et al. Simple enucleation is equivalent to traditional partial nephrectomy for renal cell carcinoma: results of a nonrandomized, retrospective, comparative study. J Urol. 2011;185(5):1604–10.CrossRefPubMed

21.

Minervini A, di Cristofano C, Lapini A, Marchi M, Lanzi F, Giubilei G, Tosi N, Tuccio A, Mancini M, della Rocca C, et al. Histopathologic analysis of peritumoral pseudocapsule and surgical margin status after tumor enucleation for renal cell carcinoma. Eur Urol. 2009;55(6):1410–8.CrossRefPubMed

22.

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(4):798–802.CrossRefPubMed

23.

Chang X, Ji C, Zhao X, Zhang F, Lian H, Zhang S, Liu G, Zhang G, Gan W, Li X, et al. The application of R.E.N.A.L. nephrometry scoring system in predicting the complications after laparoscopic renal radiofrequency ablation. J Endourol. 2014;28(4):424–9.CrossRefPubMed

24.

Huang J, Zhang J, Wang Y, Kong W, Xue W, Liu D, Chen Y, Huang Y. Comparing zero ischemia laparoscopic radio frequency ablation assisted tumor enucleation and laparoscopic partial nephrectomy for clinical T1a renal tumor: a randomized clinical trial. J Urol. 2016;195(6):1677–83.CrossRefPubMed

25.

Rosevear HM, Gellhaus PT, Lightfoot AJ, Kresowik TP, Joudi FN, Tracy CR. Utility of the RENAL nephrometry scoring system in the real world: predicting surgeon operative preference and complication risk. BJU Int. 2012;109(5):700–5.CrossRefPubMed

26.

Bruner B, Breau RH, Lohse CM, Leibovich BC, Blute ML. Renal nephrometry score is associated with urine leak after partial nephrectomy. BJU Int. 2011;108(1):67–72.CrossRefPubMed

27.

Minervini A, Vittori G, Salvi M, Sebastianelli A, Tuccio A, Siena G, Masieri L, Gacci M, Lapini A, Serni S, et al. Analysis of surgical complications of renal tumor enucleation with standardized instruments and external validation of PADUA classification. Ann Surg Oncol. 2013;20(5):1729–36.CrossRefPubMed

Title: Perioperative outcomes of zero ischemia radiofrequency ablation-assisted tumor enucleation for renal cell carcinoma: results of 182 patients
Authors: Chengwei Zhang
Xiaozhi Zhao
Suhan Guo
Changwei Ji
Wei Wang
Hongqian Guo
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Urology / Issue 1/2018
Electronic ISSN: 1471-2490
DOI: https://doi.org/10.1186/s12894-018-0356-1

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Perioperative outcomes of zero ischemia radiofrequency ablation-assisted tumor enucleation for renal cell carcinoma: results of 182 patients

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2018

Kidney stone formers have more renal parenchymal crystals than non-stone formers, particularly in the papilla region

A case of urinary bladder agenesis and bilateral ectopic ureters: a case report

The effect of mirabegron, used for overactive bladder treatment, on female sexual function: a prospective controlled study

Metastatic renal cell carcinoma initially presenting with hematochezia and subsequently with vaginal bleeding: a case report

Effect of sample time on urinary lithogenic risk indexes in healthy and stone-forming adults and children

Preoperative neutrophil-to-lymphocyte ratio predicts the surgical outcome of Xp11.2 translocation/TFE3 renal cell carcinoma patients