Irreversible Electroporation for Surgical Renal Masses in Solitary Kidneys: Short-Term Interventional and Functional Outcome

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• 作者：Steffen J. Diehl ; MD^a ; Nils Rathmann ; MD^a ; ^{nils.rathmann@umm.de" class="auth_mail" title="E-mail the corresponding author} ; Michael Kostrzewa ; MD^a ; Manuel Ritter ; MD^b ; Arman Smakic ; MD^a ; Stefan O. Schoenberg ; MD^a ; Maximilian C. Kriegmair ; MD^b
• 关键词：eGFR ; estimated glomerular filtration rate ; IRE ; irreversible electroporation ; NSS ; nephron-sparing surgery ; R.E.N.A.L. ; radius ; exophytic/endophytic ; nearness to collecting system or sinus ; anterior/posterior ; and location relative to polar lines ; RF ; radiofrequency ; ROI ; region of interest ; SI ; signal intensity
• 刊名：Journal of Vascular and Interventional Radiology
• 出版年：2016
• 出版时间：September 2016
• 年：2016
• 卷：27
• 期：9
• 页码：1407-1413
• 全文大小：421 K

文摘

To examine short-term outcomes and complications in patients with a solitary kidney treated with irreversible electroporation (IRE) for a potentially malignant renal mass.

Materials and Methods

Five patients (2 female, 3 male; mean age, 66 y) with 7 lesions who underwent IRE for renal tumors in a solitary kidney between August 2014 and August 2015 were retrospectively reviewed. Changes in signal intensity (SI) of the treated lesion were evaluated on contrast-enhanced magnetic resonance imaging. To evaluate functional outcome, creatinine levels and estimated glomerular filtration rate (eGFR) were compared vs baseline after 1 day, 2–7 days, 3–6 weeks, and 6–12 weeks after the intervention.

Results

Mean tumor diameter was 24.4 mm (range, 15–38 mm), with an average score of 7.7 (range, 4–9) per R.E.N.A.L. criteria (radius, exophytic/endophytic, nearness to collecting system or sinus, anterior/posterior, and location relative to polar lines). There was a progressive, significant decrease in treated tumor SI on follow-up imaging (mean, 70%–82%), suggesting a treatment response rate of 100% at a mean follow-up of 6.4 months (range, 3–11 mo). Two minor acute complications (Society of Interventional Radiology class A) occurred: transient gross hematuria and stage I acute kidney failure. Overall, there was no significant decrease in eGFR (−2.75 mL/min) over 3 months, even though 1 patient’s eGFR decreased from > 60 mL/min/1.73m² to 44 mL/min/1.73m².

Conclusions

The data suggest that percutaneous IRE for renal mass in patients with a solitary kidney is safe and feasible. It may help to preserve renal function and offers promising short-term oncologic results.