[Renal tumors percutaneous ablation by microwave. Initial experience.] / Ablación percutánea por microondas de tumores renales. Experiencia inicial.

OBJECTIVE: To analyze retrospectively the safety and effectiveness of percutaneous microwave ablation of solid renal tumors, and also review different approach techniques. METHODS: It is a retrospective study approved by the ethics committee of both hospitals. 14 tumors with a mean size of 37 mm (12-50 mm) were treated in a single session, under general anesthesia and with CT guidance, in 14 patients (9 men) with a mean age of 66 years, using the ablation system AMICA by different approaches (trans pulmonary, trans peritoneal and retroperitoneal). A biopsy was performed with a core needle to 13 of them prior to ablation in the same session. CT abdominal follow-up was performed (with and without i.v. contrast) at 1, 3, 6, 12, 18 and 24 months after ablation. Changes in serum creatinine levels pre- and post-ablation were also analyzed. RESULTS: The average follow-up time was 16.5 months (3-28 months) and we obtained complete response in 100% of the treated tumors. Only two minor complications were observed: one self-limited perirenal hemorrhage and one asymptomatic hydronephrosis, in the two patients to whom we did a transpulmonary approach, without pneumothorax in any of them. CONCLUSION: Percutaneous ablation of renal tumors seems to be a safe and effective technique, either via transpulmonary, transperitoneal or retroperitoneal approach, depending on tumor location. KEY POINTS: • Microwave ablation produces coagulation necrosis. • The sink effect is smaller in microwave ablation. • Microwave ablation seems to be safe and effective. • The type of approach is not correlated with major complications (Clavien > o =II).

Ablación percutánea por microondas de tumores renales. Experiencia inicial / Renal tumors percutaneous ablation by microwave. Initial experience

OBJETIVO: Analizar retrospectivamente la seguridad y eficacia de la ablación percutánea por microondas de tumores sólidos renales, así como revisar diferentes técnicas de abordaje. MÉTODOS: Es un estudio retrospectivo aprobado por el comité de ética de ambos hospitales en donde se trató en una única sesión, con anestesia general y con guía por TC 14 tumores con tamaño promedio de 37mm (12-50mm, desviación estandar 10,9) en 14 pacientes (9 varones) con una edad media de 66 años y con el sistema de ablación AMICA por diferentes vías de abordaje (transpulmonar, transperitoneal y retroperitoneal). En 13 de ellos se realizó previo a la ablación y en la misma sesión biopsia con aguja gruesa. Se realizó seguimiento mediante TC abdominal (sin y con contraste i.v.) al mes de la ablación y posteriormente a los 3, 6, 12, 18 y 24 meses posterior a la ablación. Se analizó también la modificación de los niveles de creatinina sérica pre- y post-ablación. RESULTADOS: El tiempo medio de seguimiento fue de 16,5 meses (3-28 meses) y obtuvimos respuesta completa en el 100% de los tumores tratados con tasa de supervivencia global del 100% a los 2 años y de supervivencia libre de la enfermedad del 100% a los 3 meses del tratamiento sin aparición de metástasis en las imágenes de seguimiento. Sólo observamos dos complicaciones menores Clavien-Dindo I: hemorragia perirrenal autolimitada e hidronefrosis asintomática, en los dos pacientes donde realizamos abordaje transpulmonar, sin neumotórax en ninguno de ellos. CONCLUSIÓN: La ablación percutánea de tumores renales parece una técnica segura y eficaz, ya sea por vía transpulmonar, transperitoneal o retroperitoneal según la localización del tumor. Puntos Clave: · La ablación con microondas produce necrosis por coagulación. · El efecto de sumidero es menor en la ablación con microondas. · La ablación con microondas parece ser segura y efectiva. · El tipo de abordaje no se correlaciona con complicaciones mayores (Clavien>o = II)

OBJECTIVE: To analyze retrospectively the safety and effectiveness of percutaneous microwave ablation of solid renal tumors, and also review different approach techniques. METHODS: It is a retrospective study approved by the ethics committee of both hospitals. 14 tumors with a mean size of 37 mm (12-50 mm) were treated in a single session, under general anesthesia and with CT guidance, in 14 patients (9 men) with a mean age of 66 years, using the ablation system AMICA by different approaches (trans pulmonary, trans peritoneal and retroperitoneal). A biopsy was performed with a core needle to 13 of them prior to ablation in the same session. CT abdominal follow-up was performed (with and without i.v. contrast) at 1, 3, 6, 12, 18 and 24 months after ablation. Changes in serum creatinine levels pre- and post-ablation were also analyzed. RESULTS: The average follow-up time was 16.5 months (3-28 months) and we obtained complete response in 100% of the treated tumors. Only two minor complications were observed: one self-limited perirenal hemorrhage and one asymptomatic hydronephrosis, in the two patients to whom we did a transpulmonary approach, without neumothorax in any of them. CONCLUSION: Percutaneous ablation of renal tumors seems to be a safe and effective technique, either via transpulmonary, transperitoneal or retroperitoneal approach, depending on tumor location