Complications following 573 Percutaneous Renal Radiofrequency and Cryoablation Procedures

doi:10.1016/j.jvir.2011.09.008

Journal of Vascular and Interventional Radiology

Volume 23, Issue 1, January 2012, Pages 48-54

https://doi.org/10.1016/j.jvir.2011.09.008 Get rights and content

Abstract

Purpose

To review complications related to percutaneous renal tumor ablation.

Materials and Methods

Prospectively collected data related to renal radiofrequency (RF) ablation and cryoablation procedures performed from May 2000 through November 2010 were reviewed. This included 573 renal ablation procedures performed in 533 patients to treat 633 tumors. A total of 254 RF ablation and 311 cryoablation procedures were performed; eight patients underwent simultaneous RF ablation and cryoablation. The mean age of patients at the time of the procedure was 70 years (range, 24–93 y), and 382 of 573 procedures (67%) were performed in male patients. Complications were recorded according to the Clavien–Dindo classification scheme. Duration of hospitalization was also documented.

Results

Of the 573 procedures, 63 produced complications (11.0% overall complication rate). There were 66 reported complications, of which 38 (6.6% of total procedures) were Clavien–Dindo grade II–IV major complications; there were no deaths. Major complication rates did not differ statistically (P = .15) between cryoablation (7.7%; 24 of 311) and RF ablation (4.7%; 12 of 254). Of the complications related to cryoablation, bleeding and hematuria were most common. Bleeding during cryoablation was associated with advanced age, increased tumor size, increased number of cryoprobes, and central position (P < .05). Of those treated with RF ablation, nerve and urothelial injury were most common. Mean hospitalization duration was 1 day for RF ablation and cryoablation.

Conclusions

Complications related to percutaneous renal ablation are infrequent. Recognition of potential complications and associated risk factors can allow optimization of periprocedural care.

Section snippets

Materials and Methods

Approval for this retrospective study was obtained from our institutional review board, and the study was compliant with the Health Insurance Portability and Accountability Act.

Overall Incidence of Complications

A summary of complications is provided in Table 2. Notably, of the 573 renal ablation procedures performed, a total of 66 complications, 38 of which were grade II or higher, were observed in 63 procedures (11.0%). Specifically, there were 13 grade II complications, 22 grade III complications, and three grade IV complications. There were no deaths. Transient urine retention after anesthesia occurred following 7.5% of procedures (43 of 573). Mean duration of hospitalization in all patients was 1

Discussion

With increasing acceptance of percutaneous ablation as a reasonable treatment alternative in the management of renal tumors, physicians and patients need to be familiar with the advantages and disadvantages of this focal treatment. Such complications are also considered in the establishment of practice guidelines and cost effectiveness of treatment (9, 10).

In the present review of patients undergoing renal ablation, we did not find a statistical difference in the overall complication rates for

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Safety and Technical Feasibility of Percutaneous Renal Cryoablation of Central Tumors without Pyeloperfusion
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To assess the safety and technical success of percutaneous cryoablation (PCA) without pyeloperfusion in 94 patients with central renal tumors.
A retrospective review of all central renal tumors treated by PCA without pyeloperfusion was performed. Central tumors were defined as those involving the renal sinus fat on preprocedural cross-sectional imaging. Patient demographics and baseline tumor characteristics were recorded. The details of the PCA procedure, primary and secondary technical success, rates of local recurrence, adverse events (AEs), cancer-specific survival (CSS), and overall survival (OS) were compiled.
Ninety-four patients (48 females [51%]; mean age, 68.2 years [range, 38–87 years]) with 94 central renal tumors were included. The mean maximal tumor diameter and mean RENAL nephrometry score were 37 mm (range, 15–67 mm) and 8 (range, 4–11), respectively. Primary technical success was achieved in 94% (n = 88) of procedures. Of the patients who did not achieve primary technical success, 3 underwent successful repeat PCA (secondary technical success, 97%; n = 91/94). The other 3 patients were surveilled for residual disease. Twenty-four patients (26%) required hydrodissection during PCA. Six patients (6%) experienced major AEs after PCA including hemorrhage requiring embolization (n = 3), hemorrhage requiring transfusions with admission (n = 2), and perinephric abscess necessitating drain placement (n = 1). Twenty-two patients (23%) experienced minor AEs. Nine patients (10%) experienced local recurrence during the follow-up period. OS was 94% (n = 88/94), whereas CSS was 98% (n = 92/94) during the study follow-up period (mean, 16 months [range, 1–102 months]).
PCA of central renal tumors appears to be safe with high rates of technical success, even without the use of pyeloperfusion.
Percutaneous radiofrequency and microwave ablation for renal pelvic urothelial carcinoma with refractory hematuria: A case report
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Thermal ablation for renal cell carcinoma in nephron-sparing surgery has been extensively investigated. However, data regarding renal pelvic tumors with refractory hematuria are scarce. Herein, we report a case of recurrent hematuria in an 87-year-old woman with. a 3.5 × 4.1 cm mass in the right renal pelvis on imaging examinations, which was clinically diagnosed as renal pelvic carcinoma. After ineffective renal artery embolization, minimally invasive percutaneous thermal ablation was recommended after a multidisciplinary consultation. Although hematuria was successfully relieved after ultrasound-guided radiofrequency ablation initially, recurrence of hematuria was reported due to tumor progression after one year. CT-guided microwave ablation resolved hematuria and controlled tumor growth without complications. Upper tract urothelial carcinoma (UTUC) was confirmed by biopsy. Postoperative CT imaging, urine cytology, and renal function tests were continuously monitored during the follow-up. The patient remained stable during the 1-year follow-up period, highlighting the potential of thermal ablation for refractory hematuria in renal pelvis urothelial carcinoma while preserving nephrons.
Cryoablation in large and central renal tumors: Safe and efficient percutaneous ablation techniques
2023, Journal d'imagerie diagnostique et interventionnelle
Depuis plusieurs décennies, l’incidence du cancer du rein, dont la forme la plus fréquente (90 %) est le carcinome à cellules rénales (CR), est en augmentation constante dans les pays industrialisés. Il reste l’un des cancers urologiques au pronostic le plus sombre. Actuellement, la majorité des CR sont détectées à des stades précoces, suggérant la possibilité d’une prise en charge curative. Les options thérapeutiques curatives comprennent la chirurgie (gold standard) et les techniques de thermoablation percutanée, la cryoablation étant l’une des techniques les plus fréquemment utilisées. Parmi les CR, les tumeurs intraparenchymateuses et centrales restent les plus difficiles à traiter en percutané.
Le traitement percutané des tumeurs intraparenchymateuses du rein est à très haut risque de récurrence (∼7 %) et de complications (8–20 %). Différents scores anatomiques ont été développés afin de prédire les évènements indésirables postchirurgicaux/postablation. Parmi ces scores, le C-index a été spécifiquement conçu pour identifier des tumeurs centrales. Lors de la prise en charge percutanée de CR intraparenchymateux/centraux, les risques et pièges les plus communément rencontrés sont le sink-effect (dispersion de l’énergie thermique par la vascularisation rénale), les complications hémorragiques, les fistules urinaires et la sténose de la jonction pyélo-urétérale. Afin de diminuer l’occurrence de telles complications, et notamment les complications urinaires, l’utilisation de la cryoablation (CA) apparaît comme une technique de préférence. Par ailleurs, des études précliniques sur des modèles porcins et cliniques préliminaires chez l’homme ont montré que la CA combinée à une ischémie rénale transitoire réduisait le risque de récurrence tumorale.
Pour le traitement de CR intraparenchymateux/centraux, l’utilisation de la CA et des techniques interventionnelles et scores dédiés pourrait diminuer la probabilité d’apparition de complications et augmenter les chances de contrôle tumoral local.
During the last decades, the incidence of renal cell carcinoma (RCC), which is one of the urological cancers with the poorest prognosis, is in constant increase, especially in developed countries. Currently, the majority of RCC are detected in an early stage and are, therefore, more likely to be treated in a curative way. Curative options include partial nephrectomy (gold standard) and percutaneous thermal ablation, where cryoablation (CA) is mostly used. Among CR, central and endophytic tumors are the most difficult to treat effectively with percutaneous approaches,
The percutaneous treatment of endophytic RCC is challenging due to the high risk of recurrence (∼7%) and complication (8–20%). For these reasons, different anatomical scores have been developed in order to predict adverse events after surgery/ablation, and the C-index has been specifically designed to identify central tumors. With percutaneous ablation of central RCC, the most common risks and pitfalls include the “sink-effect” (i.e. dispersion of the thermal energy induced by the renal vascularization), bleedings, urinary fistulas and ureteral stenoses. In order to lower the likelihood of these complications, especially lesions of the urinary tract, the use of CA should be preferred. Preclinical studies on swine models as well as recent preliminary clinical studies have shown that the combination of CA and transient ischemia reduces the risk of tumor recurrence.
The use of dedicated scores and interventional techniques whilst treating central RCC could lower the likelihood of complications and increase the chances of local tumor control.
A Comparison of Histotripsy and Percutaneous Cryoablation in a Chronic Healthy Swine Kidney Model
2023, Journal of Vascular and Interventional Radiology
To compare the safety and efficacy of histotripsy with cryoablation in a chronic human-scale normal porcine kidney model.
Eighteen female domestic swine were divided evenly into histotripsy and cryoablation treatment arms. A planned 2–3 cm diameter treatment was performed under ultrasound (histotripsy) or ultrasound and computed tomography (CT) guidance (cryoablation). Contrast-enhanced CT and serum blood analysis were performed immediately postprocedure and on day 7, with either immediate killing (n = 3) or continued survival to day 30 (n = 6), at which time contrast-enhanced CT, serum blood analysis, and necropsy were performed. Animal welfare, treatment zone appearance, procedure-related adverse events, and histopathology of the treatment zones and surrounding tissues were assessed.
Histotripsy treatment zones (mean ±standard deviation diameters, 2.7 ± 0.12 × 2.4 ± 0.19 × 2.4 ± 0.26 cm; volume, 8.3 ± 1.9 cm³) were larger than cryoablation zones (mean diameters, 2.2 ± 0.19 × 1.9 ± 0.13 × 1.7 ± 0.19 cm; volume, 3.9 ± 0.8 cm³; P < .001). At 30 days, histotripsy and cryoablation treatment zone volumes decreased by 96% and 83% on CT, respectively (P < .001). Perirenal hematomas were present after 8 of 9 (89%) cryoablation (mean volume, 22.2 cm³) and 1 of 9 (11%, P < .001) histotripsy (volume, 0.4 cm³) procedures, with active arterial extravasation in 4 of 9 (44%) cryoablation and no histotripsy animals (P = .206). All 9 histotripsy animals and 5 of 9 (56%) cryoablation animals had collecting system debris (P = .042). Changes in serum creatinine were similar between the groups (P = .321).
Other than a higher rate of bleeding after cryoablation, the safety and early efficacy of histotripsy and cryoablation were comparable for creating treatment zones in a chronic normal porcine kidney model.
Limited ability of the renal ablation-specific (MC)2 risk scoring system to predict major adverse events from percutaneous renal microwave ablation
2023, Clinical Imaging
To access if the (MC)2 scoring system can identify patients at risk for major adverse events following percutaneous microwave ablation of renal tumors.
Retrospective review of all adult patients who underwent percutaneous renal microwave ablation at two centers. Patient demographics, medical histories, laboratory work, technical details of the procedure, tumor characteristics, and clinical outcomes were collected. The (MC)2 score was calculated for each patient. Patients were assigned to low-risk (<5), moderate-risk (5–8) and high-risk (>8) groups. Adverse events were graded according to the criteria from the Society of Interventional Radiology guidelines.
A total of 116 patients (mean age = 67.8 [95%CI 65.5–69.9], 66 men) were included. 10 (8.6%) and 22 (19.0%) experienced major or minor adverse events, respectively. The mean (MC)2 score for patients with major adverse events (4.6 [95%CI 3.3–5.8]) was not higher than those with either minor adverse events (4.1 [95%CI 3.4–4.8], p = 0.49) or no adverse events (3.7 [95%CI 3.4–4.1], p = 0.25). However, mean tumor size was greater in those with major adverse events (3.1 cm [95%CI 2.0–4.1]) than minor adverse events (2.0 cm [95%CI 1.8–2.3], p = 0.01). Patients with central tumors were also more likely to experience major adverse events compared to those without central tumors (p = 0.02). The area under the receiver operator curve to predict major adverse events was 0.61 (p = 0.15), indicating a poor ability of the (MC)2 score to predict major adverse events.
The (MC)2 risk scoring system does not accurately identify patients at risk for major adverse events from percutaneous microwave ablation of renal tumors. The mean tumor size and central tumor location may serve as a better indicator for risk assessment of major adverse events.
Radiation Therapy in the Treatment of Localized and Advanced Renal Cancer
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: From the SIR 2011 Annual Meeting.

: None of the authors have identified a conflict of interest.

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Clinical studyComplications following 573 Percutaneous Renal Radiofrequency and Cryoablation Procedures

Abstract

Purpose

Materials and Methods

Results

Conclusions

Section snippets

Materials and Methods

Overall Incidence of Complications

Discussion

J Urol

J Urol

Seminars Nephrol

J Urol

J Vasc Interv Radiol

J Vasc Interv Radiol

J Vasc Interv Radiol

J Urol

Urology

J Vasc Interv Radiol

J Vasc Interv Radiol

J Vasc Interv Radiol

Classification of surgical complications: a new proposal with evaluation in a cohort of 6,336 patients and results of a survey

Ann Surg

Clinical study
Complications following 573 Percutaneous Renal Radiofrequency and Cryoablation Procedures