Learning objectives
To make a straightforward algorithm that allows us,
depending on the different renal tumor characteristics,
to suspect what type of postablation complications are more prone to occur and how to avoid them.
Background
Although partial or radical nephrectomy remains the treatment of choice for renal tumors,
the use of alternative treatments such as radiofrequency ablation (RFA),
microwave ablation (MWA) and cryoablation (CRA),
has been increasing in the last years.
Although these new treatments present a higher recurrence rate than surgical resection,
they are less invasive and have a low morbidity and mortality.
The most widely used is RFA.
Some patients who could not face surgery (due to their medical history,
their comorbidities or due to the tumor features)...
Findings and procedure details
The tumor characteristics on which we will base our approach and accessory protection techniques are the following ones:
Axial tumor diameter.
Location within the kidney.
Endo or exophytic.
Contact with the renal sinus fat.
Bowel proximity.
Ureter proximity.
1) AXIAL TUMOR DIAMETER:
It is the most important factor to achieve local tumor control due to the small field of tissue destruction that can be generated with most of the ablation devices and due to the limitation for monitoring this ablation zones.
If renal tumors aregreater...
Conclusion
There are a considerable number of complications that,
although infrequent,
can happen after performing percutaneous ablation techniques.
It is important for a general radiologist to be aware of,
depending on the different renal tumor characteristics (diameter,
proximity to adjacent structures,
renal location,
and endo or exophytic position),
which complications are more prone to occur (haemorrhage,
fistulae or stenosis of the urinary tract,
skin or organ burn,
persistent lumbar pain,
tumor spread,
pneumothorax,
chyluria),
how we should avoid them (previous embolization,
transhepatic approach,
pneumo/hidrodisplacement,
preablation α-receptor...
References
Schmit GD,
Kurup AN,
Weisbrod AJ,
Thompson RH,
Boorjian SA,
Wass CT et al.
ABLATE: a renal ablation planning algorithm.
Am J Roentgenol 2014;202(4):894-903.
Camacho JC,
Kokabi N,
Xing M,
Master VA,
Pattaras JG,
Mittal PK et al.
R.E.N.A.L.
(Radius,
exophytic/endophytic,
nearness to collecting system or sinus,
anterior/posterior,
and location relative to polar lines) nephrometry score predicts early tumor recurrence and complications after percutaneous ablative therapies for renal cell carcinoma: a 5-year experience.
J Vasc Interv Radiol 2015;26(5):686-93.
Kutikov A,
Uzzo RG.
The R.E.N.A.L.
nephrometry...