Abstract No. 230 Safety and Efficacy of Percutaneous Transhepatic Ablation of Right Renal Masses

To evaluate the safety and efficacy of percutaneous transhepatic ablation for the treatment of right renal masses. A retrospective analysis was conducted on patients who underwent percutaneous ablation of right renal masses using a transhepatic approach at two tertiary hospitals between January 2007 and August 2023. Patient demographics, pre-procedure and post-procedure estimated glomerular filtration rate (eGFR), renal mass characteristics (size and location), and procedural details were collected. Follow-up imaging and clinic notes were reviewed to evaluate technical success rate (complete tumor ablation), residual/recurrent tumor, and complications. Complications were categorized using the Society of Interventional Radiology new adverse event classification. A total of 39 percutaneous transhepatic ablation procedures (36 radiofrequency ablation and 3 cryoablation) were performed on 34 patients (26 males, 8 females) with a mean patient age of 67 ± 12 years. Mean follow-up was 55.1 months (range 2 months -15. 5 years). The mean size of the renal masses was 2.4 cm (± 0.7), with 55% located in the upper pole and 45% in the interpolar region. Nearly all ablated lesions were renal cell carcinoma (97.2%) except for one lesion which was an oncocytoma. All ablated renal cell carcinomas were stage 1a except one lesion was stage 1b. Patients were positioned either supine (57%) or left lateral decubitus (43%). Sonographic guidance was predominantly employed to guide ablation needle placement into the lesion (94.4%) confirmed with pre-ablation CT, while only CT guidance was utilized in the remaining cases (5.6%). Tract ablation was only performed in two ablations (5.1%). Primary efficacy on follow-up was achieved in 92.3% of cases (n = 36), with only one patient developing recurrent disease among those initially deemed to have had primary efficacy. Estimated glomerular filtration rate did not significantly change post-procedure (mean pre-procedure eGFR was 73, with mean post-procedure eGFR 71, p = 0.3). No moderate or severe adverse events related to the ablation procedures were reported. The transhepatic approach demonstrates excellent safety and efficacy in percutaneous radiofrequency ablation and cryoablation of right renal masses that may otherwise be inaccessible via an extrahepatic approach.