When is this procedure indicated?
Not all patients may be candidates for surgery. Ablation involves the destruction of cancer cells by an external energy source. In order to treat the target tissue, it is necessary to reach the tumor with needles using ultrasound or CT scan as a guide. The quality of available studies on these methods does not allow definitive indications and this treatment is reserved for patients with health problems that determine an important risk of complications in case of surgery. Other indications for which it may be used are multiple renal tumors or severe impairment of renal function.
How is it performed?
The most widely used energy sources are cryoablation and microwave thermoablation. In both cases, the most frequently used approach is percutaneous, i.e. through a puncture in the back that allows the needle to reach the target lesion on the kidney. Needle placement is monitored by ultrasound or CT scan. In more rare cases, ablative treatment can be performed during surgery and this is usually done in case of multiple tumor lesions that are treated with a combination of different treatments. Cryotherapy uses temperatures between -20°and -40°C produced by the needle tip to cause coagulative necrosis of neoplastic tissue. Thermoablation uses microwaves produced by the needle tip that heat and destroy cancer cells. At the same time, the heat generated closes small blood vessels and reduces the risk of bleeding. After both methods, dead tumor cells are gradually replaced by scar tissue.
In 9 out of 10 patients, no complications are observed after surgery. The most common side effect of the procedure is postoperative pain, which is usually mild. In some cases, bleeding may occur and transfusions may be required or, even more rarely, interventional procedures may be necessary. Other complications are possible but rare and usually dependent on the patient's starting health condition.
Most patients after surgery have a full recovery of their daily activities without any limitation or worsening of their pre-surgery health status. Long-term risks are worsening of overall kidney function with the possibility of renal failure and recurrence of the disease locally or systemically, requiring additional care.