Ablation in Renal Cell Carcinoma : Complications and when to use which.

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Purpose :
Due to the increased incidence of early-stage renal cell carcinomas (RCC), ablation has become a popular treatment option, especially for masses less than 4 cm. The various ablative techniques used for the treatment include Radiofrequency ablation (RFA), Laser ablation, Microwave ablation (MWA) and cryoablation. The advantages of these techniques over partial nephrectomy include their minimally invasive nature, decreased complication rates, and improved patient selection. In this study we compare the various methods and indications of ablation and their related complications.
Materials & Methods :
We reviewed evidence-based literature for this study.
Results :
In RFA, high frequency current is delivered through closely positioned electrodes causing cellular destruction through heat, however, charring and heat sink can limit its effectiveness. MWA overcomes these limitations by remaining independent of tissue conductivity achieving higher temperatures with a low heat sink effect resulting in a larger ablation. Cryoablation is another well-established technique in which depressurization of argon gas cause a rapid decrease in temperature (-160 degrees) and cellular death by membrane rupture, vascular thrombosis, and cell dehydration. The advantages of this procedure are the easily visualized “ice ball”, freeze zone sculpting, and reported decreased nerve and collecting system injury.
In photoablation monochromatic beam of light is focused on the area of interest to increase the temperature and cause cell death.
Post ablation syndrome is an expected and self-limiting outcome after ablation. Complications include infection, pneumothorax, tract seeding, hemorrhage, hematoma formation, and thermal damage to surrounding structures.
Conclusions :
Ablation of RCC is a safe and effective treatment against mass lesions less than 4 cm. However more randomized studies are warranted where comparisons between the ablation techniques are warranted.
Poster Abstract :
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Associated Sessions

Mayo Clinic - Florida
D.Y. Patil Medical college
Einstein Medical Center

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