Introduction

1. No.180 Radiofrequency Ablation for Small Renal Masses –Experience at Royal Perth Hospital, Western Australia Alarick Picardo1 Andrew Tan1 Martin Marshall2 James Anderson2 Department of Urology, Royal Perth Hospital, Western Australia Department of Radiology, Royal Perth Hospital, Western Australia Posters Proudly Supported by: • Results • Study population = 24 • Total # RFA procedures = 27 • Patient Characteristics • Age: median 70.5y; mean 67.6y • Gender: male 17; female 7 • Tumour Characteristics • Size • Mean = 28.6mm • Median = 30.0mm • Range = 15mm – 44mm • Location • Exophytic = 18 (72%) • Central = 1 (4%) • Intraparenchymal = 4 (16%) • Mixed = 2 (8%) • Pathology • Renal cell carcinoma = 21/25 • Oncocytoma = 2/25 • Haemangiopericytoma = 1/25 • No biopsy = 1/25 • Outcomes • Primary ablation success = 21/25 (84.0%) • Residual tumor = 3/25 (12.0%) • Repeat RFA 2/3 (both successful) • Observation 1/3 • Final success - 23/25 (92.0%) • Mean follow-up – 14.4 months • Complications (Clavien-Dindo classification of surgical complications) • Nil complications: 23/27 (85.2%) • Class I: 1/27 Simple small pneumothorax • Class II: 1/27 Subcapsularhaematoma • Class IIIa: 1/27 Infected perinephriccollection • Class IIIb: 1/27 Entero-renal fistula • Class IV: 0 • Total major complications = 2/27 (7.4%) Introduction The widespread use of abdominal imaging has led to the earlier detection of renal tumours, often before the onset of symptoms and when these masses are a much smaller size. Management options for these tumours vary depending on patient and tumour factors and can include active surveillance, surgical resection or ablative therapies. Radiofrequency ablation (RFA) is relatively new technique for renal tumours, the first series reported in the literature in 1997. It is generally reserved for patients with small cortical tumours and comorbidities that result in a high surgical risk. Success rates with RFA have been reported between 67 – 100% with a recent meta-analysis reporting primary success of 86.9% and overall success rates of 93.8%. There is however limited data on long term oncological outcomes but two studies have now reported 5 year recurrence free survival rates of 89% and 93% respectively. • Aim • To review the use of radiofrequency ablation for renal tumours at a tertiary public teaching hospital in Western Australia. • Outcomes assessed included • Tumour selection • Primary ablation success • Overall success • Complication rates Methods A retrospective review using patient files and imaging software All patients who underwent radiofrequency ablation for a renal tumour between January 2008 and September 2012 were included in this review A total of 27 RFA procedures were performed in 24 patients by one of two senior radiologists. CT guidance was used in 25 procedures and USS guidance in two. One patient received light sedation and analgesia while 26 procedures were performed under general anaesthetic. Patients were followed up with an initial CT or USS at 1 month with further follow-up performed 3 or 6 monthly. Conclusions RFA is an appropriate treatment modality that can be offered to a select group of patients with small renal masses RFA has been performed in a public teaching hospital in Western Australia with success and complication rates in accordance with international literature The future of RFA beyond its current indications will depend on further research, particularly investigating its long term oncological outcomes • References • Joniau S, Tailly T, et al. Kidney radiofrequency ablation for small renal tumors: oncologic efficacy. J Endourol. 2010 May;24(5):721-8. • Ferakis N, Bouropoulos C, et al. Long-term results after computed-tomography-guided percutaneous RFA for small renal tumors. J. Endourol. 24(12), 1909–1913 (2010) • Tracy CR, Raman JD, et al. Durable oncologic outcomes after RFA: experience from treating 243 small renal masses over 7.5 years. Cancer 116(13), 3135–3142 (2010)