1266 RADIOFREQUENCY ABLATION OF CENTRALLY LOCATED RENAL TUMORS IS ASSOCIATED WITH INCREASED RATES OF CLAVIEN GRADE 3–5 COMPLICATIONS

Abstract

INTRODUCTION AND OBJECTIVES: Radiofrequency ablation (RFA) is an effective alternative treatment for renal cell carcinoma (RCC) in patients with significant surgical risk due to comorbidity. Complications due to heat conduction to surrounding tissues are reported in 8–13% of RCC patients undergoing RFA, and result in significant increased risk of morbidity and mortality. 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 274 consecutive patients who underwent RFA for RCC between 1998 and 2008. A total of 311 tumors were treated. Mean follow-up was 4.1 years (SD 2.4). Baseline patient demographics, tumor characteristics including tumor size, location, and number of treatments were examined. Post-operative complications were graded as 0 (none), 1 (minor deviation from postoperative course), 2 (systemic therapy, including transfusion), 3 (surgical or procedural intervention), 4 (major morbidity) and 5 (fatal) according to the Clavien system of classification based on the most severe complication. RESULTS: The overall complication rate was 19.3% (n 53). A total of 14 (5.1%) of patients had moderate to severe (Clavien 3–5) complications and 39 (14%) patients had minor (Clavien 1–2) complications. Patients with centrally located tumors were more likely to develop Clavien grade 3–5 complications (p 0.016) than patients with exophytic or peripherally located tumors. Increased tumor size was significantly associated with increased risk of complications (p 0.02). Significant complications included bowel injury resulting in a fistula which resulted in a mortality, 7 ureteral strictures or obstructions, 5 cases of bleeding requiring transfusion, and 3 cases of significant RFA access tract or perinephric infections/abscesses. General anesthesia was associated with more severe complications (p 0.0001) in comparison to conscious sedation, including two cases of cardiorespiratory arrest. CONCLUSIONS: We report a 19.3% overall complication rate with a 5.1% rate of Clavien grade 3–5 complications after RFA for RCC. Complication rates from RFA are increased in patients with large, centrally located tumors tumors. In patients with higher surgical risk considering RFA, appropriate tumor selection for thermal ablation remains of paramount importance. The management of large and centrally located tumors should be considered when counseling patients regarding management options.