Management and prevention of renal ablative therapy complications

Pinkhasov, G. Igor; Raman, Jay D.

doi:10.1007/s00345-010-0550-6

Cited by 13 publications

(5 citation statements)

References 29 publications

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“…In larger tumors (>3–4 cm for RCC, >5 cm for HCC), uniform cell kill is generally not feasible and heat-sinking near vascular structures inhibits treatments near structures such as the renal sinus or large hepatic vessels. Moreover, heat diffusion can lead to unintended complications such as freezing/heating of the urinary collecting system 11 or biliary system 4 , resulting in leaks and strictures.…”

Section: Introductionmentioning

confidence: 99%

Pilot in vivo studies on transcutaneous boiling histotripsy in porcine liver and kidney

Khokhlova

Schade

Wang

et al. 2019

Sci Rep

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Boiling histotripsy (BH) is a High Intensity Focused Ultrasound (HIFU) method for precise mechanical disintegration of target tissue using millisecond-long pulses containing shocks. BH treatments with real-time ultrasound (US) guidance allowed by BH-generated bubbles were previously demonstrated ex vivo and in vivo in exposed porcine liver and small animals. Here, the feasibility of US-guided transabdominal and partially transcostal BH ablation of kidney and liver in an acute in vivo swine model was evaluated for 6 animals. BH parameters were: 1.5 MHz frequency, 5–30 pulses of 1–10 ms duration per focus, 1% duty cycle, peak acoustic powers 0.9–3.8 kW, sonication foci spaced 1–1.5 mm apart in a rectangular grid with 5–15 mm linear dimensions. In kidneys, well-demarcated volumetric BH lesions were generated without respiratory gating and renal medulla and collecting system were more resistant to BH than cortex. The treatment was accelerated 10-fold by using shorter BH pulses of larger peak power without affecting the quality of tissue fractionation. In liver, respiratory motion and aberrations from subcutaneous fat affected the treatment but increasing the peak power provided successful lesion generation. These data indicate BH is a promising technology for transabdominal and transcostal mechanical ablation of tumors in kidney and liver.

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Section: Introductionmentioning

confidence: 99%

Pilot in vivo studies on transcutaneous boiling histotripsy in porcine liver and kidney

Khokhlova

Schade

Wang

et al. 2019

Sci Rep

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“…In terms of complications, our study indicated that there was no significant statistical difference between the RFA and CA groups, which was consistent with most studies. Common complications of ablation include procedural bleeding, perirenal hematoma, and transient hematuria (34). Visceral injury or damage to the collection system may also occur.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Radiofrequency Ablation Versus Cryoablation For T1 Renal Tumors: An Evidence-Based Analysis of Comparative Outcomes

Shi

Fan

et al. 2022

Front. Oncol.

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ObjectiveTo discuss the differences in the effectiveness and security for T1 renal tumors by radiofrequency ablation (RFA) and cryoablation (CA).MethodsWe systematically searched the Cochrane Library, PubMed, Embase, CNKI databases, and Science databases, and the date was from the above database establishment to August 2021. Controlled trials on RFA and CA for T1 renal tumors were included. The meta-analysis was conducted with the Review Manager 5.4 software.ResultsA total of ten studies with 2,367 patients were included in the analysis. There were no significant differences in complications (odds ratio [OR], 1.23; 95% CI, 0.80 to 1.90; p=0.35), primary technique efficacy rate (OR, 1.01; 95% CI, 0.33 to 3.14; p=0.98), changes in serum creatinine (weighted mean difference [WMD], 0.53; 95% CI, -0.50 to 1.57; p=0.31), or 5-year survival rate (hazard ratio [HR], 1.11; 95% CI, 0.41 to 3.00; p=0.84) among patients undergoing RFA and CA. However, compared with patients who underwent RFA, patients who underwent CA had a lower Local recurrence (OR: 2.25; 95% CI: 1.38 to 3.67; p = 0.001).ConclusionThe analysis demonstrated that in the treatment of T1 renal tumors, CA may be associated with lower local recurrence rates. However, no differences were observed in terms of primary technique efficacy rate, 5-year survival rate, changes in serum creatinine, and complication rate between groups.Systematic Review Registration[https://www.crd.york.ac.uk/PROSPERO/], identifier PROSPERO (CRD42021295160).

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“…, hepatic RFA, as a result of the proximity of other vital structures, such as the bowel and ureter [14]. Nevertheless, only two articles so far have reported bowel perforation as a complication of renal RFA [15, 16]. This is the first case of appendiceal perforation occurring after (renal) RFA.…”

Section: Discussionmentioning

confidence: 99%

“…Several investigators have postulated the occurrence of bowel perforation as a complication of RFA of renal masses due to the close proximity of bowel [13, 14]. To our current knowledge, only two articles have described such a case [15, 16]. Yet in a large series of 100 percutaneously performed renal RFAs, none of the patients had colonic injuries [8].…”

Section: Introductionmentioning

confidence: 99%

Percutaneous Radiofrequency Ablation of a Small Renal Mass Complicated by Appendiceal Perforation

Boone

Bex

Prevoo

2011

Cardiovasc Intervent Radiol

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Percutaneous radiofrequency ablation (RFA) has gained wide acceptance as nephron-sparing therapy for small renal masses in select patients. Generally, it is a safe procedure with minor morbidity and acceptable short-term oncologic outcome. However, as a result of the close proximity of vital structures, such as the bowel, ureter, and large vessels, to the ablative field, complications regarding these structures may occur. This is the first article describing appendiceal perforation as a complication of computed tomography-guided RFA despite hydrodissection. When performing this innovative and promising procedure one should be aware of the possibility of particular minor and even major complications.

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Management and prevention of renal ablative therapy complications

Abstract: An understanding of complications secondary to renal ablation is essential for urologists and radiologists to facilitate prompt diagnosis, appropriate management, and future prevention.

Cited by 13 publications

References 29 publications

Pilot in vivo studies on transcutaneous boiling histotripsy in porcine liver and kidney

Pilot in vivo studies on transcutaneous boiling histotripsy in porcine liver and kidney

Comparison of Radiofrequency Ablation Versus Cryoablation For T1 Renal Tumors: An Evidence-Based Analysis of Comparative Outcomes

Percutaneous Radiofrequency Ablation of a Small Renal Mass Complicated by Appendiceal Perforation

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