Prevention and handling of complications of renal focal therapies.
Small renal lesions often confer relatively low oncologic risk and, as such, dictate for treatment strategies with low morbidity. Minimally invasive ablative techniques have been developed and can deliver good outcomes where used judiciously. The potential risks of treatment relate to the method of ablation, the route by which it is delivered, together with patient and tumor factors. The complications associated with radiofrequency ablation and cryoablation, delivered via percutaneous and laparoscopic approaches, are considered in this review. Percutaneous ablation appears to be associated with lower rates of morbidity but higher rates of recurrence when compared with laparoscopic ablation. The ability to dissect the lesion away from surrounding structures is limited with the percutaneous approach, which can lead to poor outcomes when treating lesions close to the ureter or hilum. Hemorrhagic complications that are seen with laparoscopic cryoablation are most often associated with tumor fracture during the freeze-thaw cycle. This is encountered most frequently in larger, peripheral lesions but may be mitigated by slowing the freeze rate. Postablation inpatient stays are often short, and early signs of complication are often nonspecific. This combination can lead to significant delay in the recognition of postablative problems with a resultant increase in morbidity. A high index of suspicion together with appropriate use of imaging allows for earlier detection and management of complications.
Crow
Paul
P
Bristol Urological Institute, Southmead Hospital, Bristol, United Kingdom.
Keeley
Francis X
FX
D017115:Catheter Ablation / Q000009:adverse effects*; D003452:Cryosurgery / Q000009:adverse effects*; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*