Management and prevention of renal ablative therapy complications

Introduction  

The increasing diagnosis of incidental small renal masses has contributed to energy ablative techniques being increasingly utilized as a primary surgical modality. Despite promise associated with thermal ablation, complications related to both cryoablation (CA) and radiofrequency ablations (RFA) do occur.     

Results of radiofrequency kidney tumor ablation: renal function preservation and oncologic efficacy

Objectives  

Radiofrequency ablation (RFA) is increasingly finding a place in the treatment of small renal masses (SRM). RFA may be able to provide better renal preservation, while achieving appropriate cancer control. This investigation takes a critical look at pertinent aspects of RFA principles and reviews oncological and renal function outcomes.     

Use of Percutaneous Radiofrequency Ablation in Pulmonary Metastases from Renal Cell Carcinoma

Background  

Surgical resection of pulmonary metastases from renal cell carcinoma (RCC) has been demonstrated in recent studies to produce good long-term survival outcomes. Radiofrequency ablation (RFA) may offer an alternative treatment option for this group of patients, especially for those who are unable to have surgery.     

A feasibility and dosimetric evaluation of endoscopic radiofrequency ablation for human colonic and rectal epithelium in a treat and resect trial

Background  

Endoscopic radiofrequency ablation (RFA) has been used effectively for ablation of foregut disorders and also may have a role in treating colonic pathology. This study aimed to assess the feasibility of delivering RFA to locations within the colon and to determine a range of safe treatment parameters.     

Radio frequency ablation of small renal tumors:: intermediate results

Purpose

With evolving radio frequency technology, the clinical application of radio frequency ablation (RFA) has been actively investigated in the treatment for small renal tumors. We present our intermediate patient outcomes after RFA.

Materials and Methods

Since January 2001, 17 patients with a total of 24 hereditary renal tumors ranging from 1.2 to 2.85 cm were treated with RFA using the 200 W Cool-tip RF System (Radionics, Burlington, Massachusetts) under laparoscopic (9) or percutaneous (8) guidance and had a minimum 1-year followup. A percutaneous approach was considered unsuitable if kidney tumors were contiguous to bowel, ureter or large vessels. Treatment eligibility criteria included an average tumor diameter of less than 3.0 cm, tumor growth during 1 year and solid appearance with contrast enhancement (HU change greater than 20) on computerized tomography (CT). Postoperative followup consisted of CT with and without intravenous contrast, and renal function assessment at regular intervals.

Results

Median patient age was 38 years (range 20 to 51). At a median followup of 385 days (range 342 to 691), median tumor or thermal lesion diameter decreased from 2.26 to 1.62 cm (p = 0.0013), and only 1 lesion (4%), which was located centrally near the hilum, exhibited contrast enhancement (HU change greater than 10) on CT at 12 months. Of the 15 renal tumors ablated laparoscopically, 13 were in direct contact with the bowel and 2 were abutting the ureter, necessitating mobilization before RFA. Laparoscopic ultrasound was used to guide radio frequency electrode placement and monitor the ablation process in these cases. Operative time and intraoperative blood loss (mean ± standard mean of error) were 243 ± 29 minutes and 67 ± 9 cc, respectively. In 1 patient whose ureter was adherent to the tumor a ureteropelvic junction obstruction developed after laparoscopic RFA, requiring open repair.

Conclusions

At the minimum 1-year followup 23 of 24 ablated tumors lacked contrast uptake on CT, meeting our radiographic criteria of successful RFA treatment. RFA treatment of small renal tumors using the Radionics system appears to result in superior treatment outcomes compared to those of earlier series with lower radio frequency power generators. A high wattage generator might attain more consistent energy deposition with subsequent cell death in the targeted tissue due to less convective heat loss.     

Radiofrequency ablation (RFA) therapy for renal angiomyolipoma (AML): an alternative to angio-embolization and nephron-sparing surgery

Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? The natural history of renal angiomyolipomas (AML) shows increasing size and increasing risk of haemorrhage. For those patients undergoing treatment, extirpative surgery or renal angio‐embolization has increased morbidity. Due to its haemostatic effect, radio‐frequency ablation (RFA) may be used safely and effectively for the treatment of small (<4 cm), symptomatic renal AML. This study represents the largest case series reporting on RFA for renal AML.

OBJECTIVES

? To show that radiofrequency ablation (RFA) is safe and effective treatment for renal angiomyolipoma (AML). ? Current treatments to reduce the risk of haemorrhage include tumour extirpation, angio‐embolization, or ablative therapy.

PATIENTS AND METHODS

? Review of our prospective database revealed 15 patients with intraoperative biopsy confirmed renal AML undergoing RFA from February 2002 to March 2010. ? Patients underwent either laparoscopic or computed tomography (CT)‐guided percutaneous RFA using either the Cool‐tip? (Covidien, Inc. Boulder, CO, USA) or RITA? (Angiodynamics®, Latham, NY, USA) RFA probe. ? CT at 1 month, 6 months, 1 year, and annually thereafter.

RESULTS

? In all, two male and 13 female patients with seven left‐sided and eight right‐sided tumours with a mean (range) size of 2.6 (1.0–3.7) cm underwent laparoscopic (five) or CT‐guided (10) RFA. ? No intraoperative complications occurred. Minor complications included transient haematuria and intercostals nerve transection. Surgical complications included pneumonia and myocardial infarction. ? There was no radiographic evidence of persistent AML (CT enhancement) at a mean follow‐up of 21 months.

CONCLUSIONS

? The haemostatic effect of RFA allows renal lesions suspicious for AML to be treated without bleeding complications. ? Avoids surgical risk of extirpation or embolization. ? RFA for renal AML is safe and effective.     

Treatment of Renal Tumors by Percutaneous Ultrasound-Guided Radiofrequency Ablation Using a Multitined Electrode: Effectiveness and Complications

Background

Radiofrequency ablation (RFA) is a minimally aggressive, therapeutic alternative for renal tumors. It can be an alternative to nephrectomy in patients with previous nephrectomy, bilateral tumors, von Hippel-Lindau disease, or small renal carcinomas and in those with contraindications for surgery.

Objective

To assess the effectiveness of the treatment of renal tumors by RFA in the short and medium term and to identify the possible complications and the factors that determine therapeutic success.

Design, setting, and participants

A retrospective review of patients with renal tumors treated with RFA between May 2005 and December 2008 was performed in a tertiary academic hospital. Patients were selected among those with previous nephrectomy, bilateral neoplasms, von Hippel-Lindau disease, surgical risk, comorbidity, advanced age, or patient's refusal to surgery. Tumors with evidence of extrarenal extension were excluded. Patients were followed up for 10–50 mo using computed tomography and magnetic resonance imaging.

Intervention

Ultrasound-guided RFA was performed on 65 tumors (range: 1.2–5.3 cm) of 58 patients using multitined electrodes.

Measurements

Incomplete ablation rate, therapeutic success rate, and complications rate.

Results and limitations

Therapeutic success was achieved in 59 of 65 tumors (91%): 53 in a single session, 5 in two sessions, and 1 in three sessions. A significant relationship was observed between size and growth pattern of the tumor and both therapeutic success and incomplete ablation rates. Therapeutic success in tumors >5 cm was 60%. Complications were detected in 10 patients (13%); 5% were considered major complications.Limitations include the lack of pathologic studies to confirm a complete ablation and the lack of a control group to compare with the results of those who underwent nephrectomy.

Conclusions

RFA is safe and effective in renal tumors. Corticomedullary lesions and tumors >3 cm have greater possibility of incomplete ablation. In tumors >5 cm, RFA has a significant failure rate.     

Preoperative patient counseling for diagnostic renal biopsy and complications with renal radiofrequency ablation

Purpose

To identify preoperative factors associated with surgical complications and successful diagnostic renal biopsy in both laparoscopic and percutaneous radiofrequency ablation (RFA) of renal masses in order to help aid in preoperative patient counseling for renal RFA.

Methods

We reviewed our Institutional Review Board approved database from November 2001 to January 2011, containing 335 tumors treated with either laparoscopic (LRFA) or percutaneous RFA (CTRFA). Preoperative patient demographics, tumor characteristics, and intraoperative surgical data were collected along with biopsy results and clinicopathologic outcomes.

Results

RFA was performed on 335 renal tumors (124 LRFA, 211 CTRFA). Non-diagnostic biopsy occurred in 18 (5.5%) tumors. Of the 317 procedures performed, 121 complications occurred in 103 (30.7%) procedures. Multivariate analysis only showed CTRFA (vs LRFA) to increase the likelihood of non-diagnostic biopsy (OR 5.1, 95% CI 1.2–22, p = 0.032). Increased tumor size (p = 0.007) and synchronous ablations (p = 0.019) increased the risk for major complications, while decreased surgeon experience (p = 0.003) and tumors close to the collecting system (p = 0.005) increased the risk of any complication.

Conclusions

Preoperative recommendations can be made to patients in the future. We suggest counseling patients that when undergoing RFA, percutaneous approach increases the risk of non-diagnostic biopsy, increased tumor size increases the risk of major complications, having more than 1 tumor ablated increases the risk of a major complication, and tumors close to the collecting system may increase the risk of complications.     

Tolerance of radiofrequency ablation by patients of hepatocellular carcinoma

Background  

Radiofrequency ablation (RFA) is currently an effective method for ablation of hepatocellular carcinoma (HCC). Early reports have indicated that RFA is safe and virtually free from major complications. Unlike partial hepatectomy for HCC on patients with cirrhosis, there are no data on the safety limit of RFA. However, information is vital for selection of appropriate patients for the procedure. In this study, we analyzed results from use of RFA on HCC patients and determined the lower limit of liver function with which HCC patients can tolerate RFA.     

Comparative Assessment of the Safety and Effectiveness of Radiofrequency Ablation Among Elderly Medicare Beneficiaries with Hepatocellular Carcinoma

Background  

Radiofrequency ablation (RFA) use among patients with hepatocellular carcinoma (HCC) has increased dramatically over the last decade, but assessments outside specialized centers are lacking. This population-based study was intended to evaluate the safety and effectiveness of RFA when used to treat HCC.     

Computed tomography (CT)-guided versus laparoscopic radiofrequency ablation: a single-institution comparison of morbidity rates and hospital costs

Background  

Computed tomography (CT)-guided radiofrequency ablation (RFA) is presumed to be less morbid and less costly than laparoscopic RFA. This analysis investigates the 30-day morbidity, hospital cost, and reimbursement for CT-guided RFA versus laparoscopic RFA used to manage hepatocellular carcinoma (HCC) and colorectal liver metastases (CRLM).     

Perkutane computertomographiegezielte Radiofrequenzablation bei kleinen Nierentumoren

Background

The incidence of small renal masses has increased in recent decades. Standard surgical treatment may not be applicable in patients with advanced age or severe comorbidities. Therefore, minimally invasive therapeutic approaches, such as radiofrequency ablation (RFA), may be a therapeutic option for such patients.

Objectives

Assessment of oncological and functional outcomes of percutaneous RFA in small renal masses.

Materials and methods

Single center evaluation of all RFA performed at the hospital Landesklinikum Baden from 2006–2016.

Results

A total of 98 RFA were performed in 85 patients. Mean patient age was 69.5 years. Median tumor size was 26.2?mm, while the length of hospital stay was 1.4 days. Overall, 96.8% of RFA procedures were considered to be technically complete. Recurrence rate was 17.5%. Most of the recurrences were treated via a second RFA. Complication rates were fairly low as the vast majority of ablations were free of complications (82.7%). Grade I, II and III complications (according to the Clavien-Dindo classification) occurred in 13.3%, 3% and 1%, respectively. A significant deterioration of renal function due to RFA was not observed. Cancer-specific survival rate for renal cell carcinoma was 100%; overall survival was 84.7% after an average follow-up period of more than 3 years.

Conclusion

RFA is an adequate alternative treatment option for small renal masses in patients unfit to undergo surgical excision. Patients benefit from the low complication rates, preservation of renal function, and short hospital stays.

     

Radiofrequency Ablation of Hepatic Metastases: Factors Influencing Local Tumor Progression

Background

Although radiofrequency ablation (RFA) of nonresectable hepatic metastases has gained wide acceptance by showing survival benefit in selected patients, scattered reports are available regarding risk factors of local control of percutaneous RFA. The purpose of this study was to prospectively evaluate the factors influencing local tumor progression after percutaneous RFA of hepatic metastases.

Methods

Sixty-nine hepatic metastatic lesions in 54 patients were treated by percutaneous RFA. Efficacy was evaluated by contrast-enhanced computed tomography or magnetic resonance imaging at 1 month after ablation, then at 3-month intervals for the first year and biannually thereafter.

Results

The results of the log-rank test showed that tumor size of <3 cm (p = 0.024) and the absence of tumor contiguous with large vessels (p = 0.002) significantly correlated with local control for hepatic metastases. Cox regression analysis showed that the tumor size <3 cm and the absence of tumor contiguous with large vessels were independent factors (p = 0.055 and 0.009, respectively). The results of the log-rank test showed that neither the threshold post-ablation margin of 1.8 cm (p = 0.064) nor the presence of a tumor with subcapsular location (p = 0.134) correlated with the success of local control.

Conclusions

Percutaneous RFA is more effective in achieving local control in patients with hepatic metastases when the tumor size is <3 cm and not contiguous with large vessels.     

Real-time virtual ultrasonographic radiofrequency ablation of renal cell carcinoma

OBJECTIVE

To evaluate the usefulness of real‐time virtual ultrasonography (RVS) as a new navigational tool for percutaneous radiofrequency ablation (RFA) of solid renal cell carcinoma (RCC).

PATIENTS AND METHODS

Ten patients with 13 RCCs were treated with percutaneous RFA using RVS, which displays ultrasonograms and corresponding multiplanar reconstruction images of computed tomography in parallel.

RESULTS

RVS allowed excellent anatomical visualization and precise navigation of RFA for RCC. All patients were treated successfully in one session with percutaneous RVS RFA. There were no significant complications, and none of the patients had a local tumour recurrence during the follow‐up.

CONCLUSION

RVS for RFA of solid RCC is a new and promising alternative imaging method.     

Radiofrequency Ablation (RFA) of Benign Thyroid Nodules in Patients with Incompletely Resolved Clinical Problems after Ethanol Ablation (EA)

Background  

Although ethanol ablation (EA) is effective, refractory cases have been reported in 5–25% of patients, with a marked decline in efficacy on subsequent reattempt. The aim of this study was to evaluate the role of radiofrequency ablation (RFA) after EA of benign thyroid nodules in patients with incompletely resolved initial clinical problems.     

Large Volume Hepatic Microwave Ablation Elicits Fewer Pulmonary Changes than Radiofrequency or Cryotherapy

Background  

Lung changes after microwave tissue ablation (MTA) of different volumes of liver were compared with hepatic resection, cryotherapy (CRYO) and radiofrequency ablation (RFA).     

Radiofrequency Ablation Versus Surgical Resection for Hepatocellular Carcinoma in Childs A Cirrhotics—a Retrospective Study of 1,061 Cases

Introduction  

The long-term outcomes of radiofrequency ablation (RFA) vs. surgical resection in cirrhotic patients with hepatocellular carcinoma (HCC) remain controversial. One thousand sixty-one cirrhotic HCC patients were included into a retrospective study. Four hundred thirteen received RFA and 648 received surgical resection.     

Resection and radiofrequency ablation in the treatment of hepatocellular carcinoma: a single-center experience

Background  

We have been utilizing both resection and laparoscopic radiofrequency ablation (RFA) to treat hepatocellular carcinoma (HCC). The aim of this study is to describe patient characteristics and outcome for each treatment modality from a single institution.     

Complications after percutaneous ablation of liver tumors: a systematic review

Background

Although ablation therapy has been accepted as a promising and safe technique for treatment of unrespectable hepatic tumors, investigation of its complications has been limited. A physician who performs ablation treatment of hepatic malignancies should be aware of the broad spectrum of complications. Proper management is possible only if the physician Performing ablation understands the broad spectrum of complications encountered after ablation.

Objectives

To systematically review the complications after different ablation modalities: Radiofrequency ablation (RFA), microwave ablation (MWA) and Nano knife for the treatment of liver tumors and analyze possible risk factors that precipitate these complications.

Search methods

We performed electronic searches in the following databases: MEDLINE, EMBASE and COCHARNE. Current trials were identified through the Internet (from January 1, 2000 to January 1, 2014). We included only studies who specific mentioned complications after liver ablation therapy (RFA/MWA/Nano knife).

Main results

A total of 2,588 publications were identified, after detailed examination only 32 publications were included in the review. The included studies involved 15,744 participants. According to the type of technique, 13,044 and 2,700 patients were included for RFA and MWA. Analysis showed a pooled mortality of 0.15% for RFA, and 0.23% for MWA.

Conclusions

This systematic review gathers information from controlled clinical trials and observational studies which are vulnerable to different types of bias, never the less RFA and MWA can be considered safe techniques for the treatment of liver tumors.     

Percutaneous Radiofrequency Ablation versus Partial Hepatectomy for Multicentric Small Hepatocellular Carcinomas: A Nonrandomized Comparative Study

Background  

The aim of this study was to compare the results of percutaneous radiofrequency ablation (RFA) with those of partial hepatectomy (PH) in the treatment of multicentric small hepatocellular carcinomas (HCCs). With advances in RFA, it is not known whether the minimally invasive approach with percutaneous RFA could attain comparable survival outcomes but with a lower morbidity in patients with multicentric HCCs.