Fisher Garrett, Kaufman Hannah, Wilcox Amanda, Torralba Ericson, Boldman Emily, Boyer Brendan, Hakim Jonathon, Short Robert
Wright State University Boonshoft School of Medicine, Wright State University, Dayton, Ohio.
Department of Diagnostic and Therapeutic Imaging, Dayton VA Medical Center, Dayton, Ohio.
J Vasc Interv Radiol. 2025 Jul;36(7):1171-1178.e1. doi: 10.1016/j.jvir.2025.03.024. Epub 2025 Apr 8.
To determine the technical success, adverse events, local tumor recurrence, and survival in adult patients undergoing microwave ablation (MWA) of small renal masses performed exclusively under moderate sedation.
A single-institution, retrospective review from 2016 to 2023 of percutaneous, computed tomography-guided MWA for small renal masses (<4 cm) was performed. After addressing exclusion criteria, 66 patients undergoing 72 ablations were included. Patient demographics, comorbidities, tumor characteristics, procedural details, and clinical outcomes were evaluated. Kaplan-Meier analysis of progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS) was performed. Kidney function before and after ablation was compared using the nonparametric Mann-Whitney U test.
Seventy-two small renal masses with a mean size of 2.2 cm (SD ± 0.7) underwent MWA with a 2.45-GHz gas-cooled MWA system at 65 W for 5-15 minutes (mean, 39.1 kJ) performed under moderate sedation. Demographics included a mean age of 68.4 years (SD ± 8.3) (n = 62 men) and Charlson Comorbidity Index score of 6.2 (SD ± 2.1). Median sedation doses were 150 mcg (interquartile range [IQR], 100-175 mcg) of fentanyl and 2.5 mg (IQR, 2-3.5 mg) of midazolam. Technical success was 100%, and all patients were discharged the same day. Median follow-up duration was 3.1 years. PFS and OS were 88.1% and 91.9% at 3 years, respectively. CSS was 100%. There were 2 mild adverse events (2.8%) and 3 recurrences (4.2%). Only 9.7% (n = 5) of patients required postprocedural analgesia; no patients required postdischarge analgesic prescriptions.
MWA of small renal masses under moderate sedation alone demonstrates excellent patient safety profile, tolerability, and effectiveness, allowing operational efficiency, including short procedure times and same-day discharge.
确定仅在中度镇静下接受小肾肿块微波消融（MWA）的成年患者的技术成功率、不良事件、局部肿瘤复发率和生存率。
对2016年至2023年在单一机构进行的经皮计算机断层扫描引导下对小肾肿块（<4 cm）进行的MWA进行回顾性研究。在排除排除标准后，纳入66例接受72次消融的患者。评估患者的人口统计学特征、合并症、肿瘤特征、手术细节和临床结果。对无进展生存期（PFS）、癌症特异性生存期（CSS）和总生存期（OS）进行Kaplan-Meier分析。使用非参数Mann-Whitney U检验比较消融前后的肾功能。
72个平均大小为2.2 cm（标准差±0.7）的小肾肿块在中度镇静下使用2.45 GHz气冷MWA系统以65 W进行5至15分钟（平均39.1 kJ）的MWA。人口统计学特征包括平均年龄68.4岁（标准差±8.3）（n = 62名男性），Charlson合并症指数评分为6.2（标准差±2.1）。中位镇静剂量为芬太尼150 mcg（四分位间距[IQR]，100 - 175 mcg）和咪达唑仑2.5 mg（IQR，2 - 3.5 mg）。技术成功率为100%，所有患者均于当日出院。中位随访时间为3.1年。3年时PFS和OS分别为88.1%和91.9%。CSS为100%。有2例轻度不良事件（2.8%）和3例复发（4.2%）。仅9.7%（n = 5）的患者需要术后镇痛；无患者需要出院后镇痛处方。
仅在中度镇静下对小肾肿块进行MWA显示出极佳的患者安全性、耐受性和有效性，可提高手术效率，包括缩短手术时间和当日出院。
