Laparoscopic RFA: 32-month follow-up results

Laparoscopic radiofrequency ablation (RFA) may be as effective for small renal tumours as percutaneous RFA or partial nephrectomy, according to a review of 106 cases (Ji et al. Urology 2011; 77: 798-802; www.ncbi.nlm.nih.gov/pubmed?term=Ji%20C%2C%20Li%20X%2C%20Zhang%20S%2C%20Gan%20W%2C%20Zhang%20G).

Laparoscopic RFA was performed in the period 2006-2008. Tumour size ranged from 0.9-5.5 cm. Biopsies were obtained prior to RFA; 84.9% were diagnosed as RCC. Contrast-enhanced CT was performed 7 days after the procedure, with follow-up CTs at 3 and 6 months and every 6 months thereafter. The mean follow-up was 32 months.

The local tumour control rate was 98.1%. In the 90 RCC cases, disease-free survival was 97.8%; the cancer-specific and overall survival rates were 100%. There were no cases of renal failure or death.

Previous studies have suggested that percutaneous RFA may be useful in unresectable stage 1 RCC, notably for smaller (< 4 cm) tumours (Arima et al. Int J Urol 2007; 14: 585-590; www.ncbi.nlm.nih.gov/pubmed/17645597). A meta-analysis of renal tumour ablation techniques reported that a surgical approach was more effective than a percutaneous approach (64% vs. 87%), with effectiveness defined as the proportion of tumours with no residual enhancement after one session (Hui et al. J Vasc Interv Radiol 2008; 19: 1311-1320; www.ncbi.nlm.nih.gov/pubmed/18725094). Secondary effectiveness (no residual enhancement after repeated treatments) was comparable (95% vs. 92%). There were fewer major complications with percutaneous versus surgical treatment (3% vs. 7%).

Comment
Dr. Anil Kapoor: Radiofrequency ablation (RFA) and cryo-ablation (CA) are emerging as effective options for the treatment of small kidney tumours. Management options for the small renal mass (SRM) include active surveillance, probe ablation (RFA or CA), or partial nephrectomy (laparoscopic, robotic, or open). Our choice of approach for probe ablation, either laparoscopic or percutaneous, depends on the tumour location. If the tumour is anterior, then a laparoscopic approach is preferred, with bowel mobilization to minimize the risk of a bowel injury that may occur with a percutaneous approach, and direct visualization with laparoscopic ultrasound for accurate probe placement. If the tumour is posterior, a percutaneous approach is preferred, with its direct posterior probe placement. This is preferable over the laparoscopic approach to posterior tumours; unless the retroperitoneal approach is used, with a transperitoneal approach the kidney has to be mobilized and then "flipped over" to approach a posterior tumor. The studies referenced above illustrate that laparoscopic probe ablation is at least effective, if not superior, compared to percutaneous probe ablation