Complications Of Image-Guided Radiofrequency Ablation Of Renal Cell Carcinoma: Causes, Imaging Features And Prevention Methods

Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology
Article Date: 15 Jun 2009 - 0:00 PDT

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UroToday.com - Radiofrequency (RF) ablation of renal cell carcinoma (RCC) has been accepted as a minimally invasive treatment for patients who are not able to undergo surgery1. These patients have such poor medical conditions that they can have a higher risk of postoperative morbidity or mortality compared to the general population.

Despite a minimally invasive nature, RF ablation may cause a variety of major or minor complications because of unwanted heat conducting to several organs in close proximity to RCC. Most of all, great care should be taken not to injure bowel and ureter during RF ablation because emergent intervention or open surgery may be required for these complications2, 3. If the bowel is thermally injured, bowel perforation may occur and subsequently cause life-threatening complications such as abscess formation and sepsis. If the ureter is injured, ureteral stricture may occur and deteriorate renal function. Therefore, interventional physicians should thoroughly review pre-ablation CT or MR images to know how close the bowel and ureter are to RCC.

Even though we did not mention about them in the review, attention should be paid to excessive radiation exposure and hypertensive crisis, both of which may develop during RF ablation. Patients undergoing CT-guided RF ablation are exposed to a considerable amount of radiation. MR imaging is a guiding modality for tumor targeting but MR compatible RF electrode is not widely available. MRI-guided cryoablation is an alternative ablation therapy for RCC without fearing radiation exposure4.

Catecholamine may excessively excrete and subsequently cause hypertensive crisis if the adrenal gland abutting upper polar RCC is ablated. Therefore, intravenous antihypertensive medication should be prepared to use in this clinical setting.

In conclusion, interventional physicians should be familiar with various causes, imaging features, and prevention methods of complications occurring during image-guided RF ablation of RCC if this ablation therapy is to be considered as a treatment of modality for patients who have high risk at surgery.

References:

1. Park, B. K., Kim, C. K.: Complications of image-guided radiofrequency ablation of renal cell carcinoma: causes, imaging features and prevention methods. Eur Radiol, 2009
2. Park, B. K., Kim, S. H., Byun, J. Y. et al.: CT-guided instillation of 5% dextrose in water into the anterior pararenal space before renal radiofrequency ablation in a porcine model: positive and negative effects. J Vasc Interv Radiol, 18: 1561, 2007
3. Park, B. K., Kim, C. K.: Mechanical Ureteral Perforation by a Radiofrequency Electrode during Ablation of a Renal Tumor. Cardiovasc Intervent Radiol, In press, 2009
4. Silverman, S. G., Tuncali, K., vanSonnenberg, E. et al.: Renal tumors: MR imaging-guided percutaneous cryotherapy--initial experience in 23 patients. Radiology, 236: 716, 2005

Written by Byung Kwan Park, MD#, et al. as part of Beyond the Abstract on UroToday.com

#The Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine

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