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Radiofrequency Ablation of Centrally Located Renal Tumors is Associated with Increased Rates of Major Complications
Sarah P. Psutka, MD, Ali Daha, BA, Debra Gervais, MD, Adam S. Feldman, MD.
Massachusetts General Hospital, Boston, MA, USA.

Introduction: Radiofrequency ablation (RFA) has emerged as an effective alternative treatment for RCC in patients unable to undergo surgery. Complications due to heat conduction to surrounding tissues are reported in 8-13% of patients undergoing RFA for renal tumors, and result in significant increased risk of morbidity and mortality for patients, specifically those who might require further treatment for locally recurrent tumor. The objective of this study is to identify risk factors for complications based on renal tumor characteristics, in an effort to improve patient selection criteria for RFA..
Methods: We retrospectively reviewed the outcomes of 313 consecutive patients who underwent RFA for renal cell carcinoma between 1998 and 2008. Mean follow-up was 3 years (SD 2.1). Baseline patient demographics, tumor characteristics including tumor size, location, number of treatments within each procedure and number of repeat treatments overall were examined. Major complications (MajC) required intervention, including bowel injury, ureteral injury, bleeding requiring transfusion or evacuation, cardiopulmonary failure. Minor complications (MinC) that may require only observation include pain, hematoma, hematuria, neuromuscular injury, clinically insignificant pneumothorax, infarction and inflammation of the RFA tract.
Results: The overall complication rate was 19% with MajC occurring in 19 patients (6%) and MinC in 41 patients (13%), Of those patients with MajC, there was one bowel injury resulting in a fistula requiring surgical repair which resulted in a mortality, 7 ureteral or renal pelvis injuries, 7 cases of significant bleeding, requiring 5 transfusions, 3 cases of significant RFA access tract or perinephric infections/abscesses, and 2 patients who required cardiopulmonary rescuscitation during the RFA procedure. MinC comprised of pain (15), hematoma (17), and clinically insignificant pneumothorax (3). Complication rates increased with the number of repeat procedures (p = 0.01), but not the number of treatments within a single treatment (p = 0.3). Patients with centrally located tumors were more likely to develop a major complication (p = 0.027) than patients with exophytic or peripherally located tumors. Increased tumor size was significantly associated with increased risk of complications (p = 0.033).
Conclusions: We report a 19% overall complication rate with a 6% rate of major complications after RFA for renal tumors in patients who are not suitable surgical candidates. This is one of the largest series of RFA reported in the literature. Complication rates are increased in patients with centrally located tumors and larger tumors. Appropriate patient selection for thermal ablation remains of paramount importance. The management of large and centrally located tumors should be considered when counseling patients regarding treatment options.


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