Type:
Educational Exhibit
Keywords:
Neoplasia, Cancer, Ablation procedures, Ultrasound, CT, Kidney, Interventional non-vascular
Authors:
Y. Lamprecht, P. Lastra Garcia-Barón, E. Marín Diez, E. Montes Figueroa, V. Fernández Lobo, P. Gallego Ferrero; Santander/ES
DOI:
10.1594/ecr2018/C-3025
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) become candidates for treatment thanks to these techniques.
These new treatments are indicated especially in:
- Patients with a single kidney.
- Patients with bilateral renal carcinoma (those with a family tendency as it happens in von Hippel Lindau syndrome or in the familial form of papillary cancer).
- Patients with comorbidities that contraindicate surgery.
- Patients who reject surgery.
- Patients older than 75 years (there is no lower survival than in total nephrectomy).
- Patients with metastatic clear cell renal carcinoma (to alleviate the paraneoplastic syndrome).
Different complications can occur.
The most frequent ones are:
- Hemorrhage [ Fig. 1,
Fig. 2]: hematuria (central tumor) or perirenal hematoma (exophytic tumor).
- Damage to the urinary tract: fistulas [ Fig. 3 ] or stenosis [ Fig. 4 ].
- Burn of neighboring organs: bowel,
spleen,
pancreas,
adrenal glands,
and skin.
- Sensory deficits or paresthesias in the lumbar area (due to the lesion of the genitofemoral or the lateral femoral cutaneous nerves) [ Fig. 5 ].
- Pneumothorax.
- Tumor spread through the needle tract.
- Chyluria [ Fig. 6 ].
Chyluria requires a lymphaticourinary fistulous connection.
The location of the fistula often occurs at the calyceal fornix in the renal pelvis.
Despite the fact that it was thought that the only tumors susceptible to ablative treatment were the small ones with an exophytic location,
the improvement in the devices and the displacement techniques have increased the number of renal masses susceptible to treatment.
Even so,
the risk of complication persists when performing these procedures,
so we must know the possible complications and how we could avoid them in advance.