Protecting the Ureter during Radiofrequency Ablation of Renal Cell Cancer: A Pilot Study of Retrograde Pyeloperfusion with Cooled Dextrose 5% in Water

• Published in: Journal of vascular and interventional radiology Vol. 19; no. 7; pp. 1034 - 1040
• Main Authors: Cantwell, Colin P., MB, BCh, BAO, MSc, MRCS, FRCR, FFR, Wah, Tze M., MD, Gervais, Debra A., MD, Eisner, Brian H., MD, Arellano, Ronald, MD, Uppot, Raul N., MD, Samir, Anthony E., MD, Irving, Henry C., MD, McGovern, Francis, MD, Mueller, Peter R., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2008
• Subjects: Aged; Boston; Carcinoma, Renal Cell - pathology; Carcinoma, Renal Cell - surgery; Catheter Ablation - adverse effects; Cold Temperature; England; Feasibility Studies; Female; Glucose - therapeutic use; Humans; Hydronephrosis - etiology; Hydronephrosis - prevention & control; Kidney Neoplasms - pathology; Kidney Neoplasms - surgery; Male; Neoplasm Recurrence, Local; Neoplasm, Residual; Perfusion; Pilot Projects; Radiology; Reoperation; Retrospective Studies; Tomography, X-Ray Computed; Treatment Outcome; Ureteral Diseases - etiology; Ureteral Diseases - prevention & control; Urinary Catheterization; England; Boston; renal cell carcinoma; RCC; RF; dextrose 5% in water; D5W; radiofrequency
• ISSN: 1051-0443; 1535-7732
• DOI: 10.1016/j.jvir.2008.04.005

Purpose To describe early experience with cooled dextrose 5% in water (D5W) solution retrograde pyeloperfusion during radiofrequency (RF) ablation of renal cell carcinoma (RCC) within 1.5 cm of the ureter with respect to feasibility, safety, and incidence of residual/recurrent tumor in proximity to the cooled collecting system. Materials and Methods Between November 2004 and April 2007, 17 patients underwent 19 RF ablation sessions of RCCs within 1.5 cm of the ureter during cooled D5W pyeloperfusion (nine men, eight women; mean tumor size, 3.5 cm; mean age, 73 y; mean distance to ureter, 7 mm). RF ablation was performed with pulsed impedance control current. The records and imaging studies of patients treated with this technique were reviewed for demographics, indication, technique, complications, and tumor recurrence. Results All 19 RF ablation and ureteral catheter placement procedures were technically successful. No patient developed a ureteral stricture or hydronephrosis during a mean of 14 months of follow-up (range, 4–32 months). Three patients had residual tumor on the first follow-up imaging study, but all three tumors were completely ablated after a second RF ablation session. No complications or deaths occurred. No recurrent tumor was seen anywhere in the treated tumors, and there was complete ablation of the tumor margin in proximity to the collecting system. Conclusions RF ablation of RCC within 1.5 cm of the ureter is feasible with cooled D5W retrograde pyeloperfusion and is not associated with reduced efficacy, ureteral injury, or early recurrence.