Radiofrequency ablation for T1a tumors in a solitary kidney: promising intermediate oncologic and renal function...

The experience with radiofrequency ablation (RFA) in solitary kidneys is limited in numbers and follow-up. Therefore, we report our oncologic and renal function outcomes of RFA for T1a tumors in patients with a solitary kidney.

From April 2000 to August 2007, 242 patients were treated with RFA for renal cortical masses. Sixteen patients with localized tumors < or = 4 cm in a solitary kidney were identified. Clinical and radiographic data were reviewed to assess indications, complications, disease recurrence, and renal function.

Twenty-one renal masses were ablated in 16 patients with a solitary kidney. The mean patient age was 66.1 years, and the mean tumor size was 2.6 cm (range, 1.1-4.0). Preoperative biopsy was diagnostic of renal cell carcinoma (RCC) in 75% of cases. At a mean follow-up of 30.7 months (range, 1.5-66.0), 14/16 (88%) patients had no radiographic evidence of disease recurrence. One patient with three masses in a solitary kidney had a local recurrence managed by salvage RFA. The other patient with a local failure also had severe baseline renal insufficiency with progression to end stage renal disease 2.5 years following RFA and underwent a radical nephrectomy. Mean glomerular filtration rate (GFR) decreased from 54.2 ml/min/1.73m2 preoperatively to 47.5 ml/min/1.73m2 at last follow-up (p = 0.015). There were no major complications, and four patients had minor complications which resolved without intervention.

Radiofrequency ablation is an attractive alternative for the management of patients with T1a renal cortical tumors in a solitary kidney. Renal function appears to be adequately maintained with promising oncologic outcomes at 2.5 years.