[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

Arterial Calcium Stimulation with Hepatic Venous Sampling in the Localization Diagnosis of Endogenous Hyperinsulinism.

Objective. The aim of this study was to assess the utility of arterial calcium stimulation with hepatic venous sampling (ASVS) in the localization diagnosis of endogenous hyperinsulinism. Patients and Methods. A retrospective descriptive study was performed including patients with endogenous hyperinsulinism who underwent ASVS. The histopathological diagnosis in patients who underwent a surgical procedure was used as the reference for the statistical study of the accuracy of this technique. Results. 30 patients were included with endogenous hyperinsulinism and nonconclusive imaging diagnosis was included. ASVS was performed in all cases. Surgery was performed in 20 cases. Insulinoma was removed in 19 patients; the location of all cases was detected in the ASVS. All cases of endogenous hyperinsulinism had a positive result for the ASVS, with this association being statistically significant (χ2 = 15.771; p < 0.001). A good and statistically significant agreement was obtained between histopathologic diagnosis and ASVS results (K = 0.518, p < 0.001). Conclusions. ASVS is a useful procedure in the localization diagnosis of endogenous hyperinsulinism undetected by other imaging tests. This technique allows the localization of intrapancreatic insulinomas and represents useful tool for the diagnosis and surgical management of these tumors.