Radiofrequency Ablation (RFA) in Cyprus
Radiofrequency Ablation (RFA) describes the procedure in which Dr Zertalis uses ultrasound (US) and/or computed tomography (CT) to navigate a fine needle into an area of suspected or confirmed cancer in the kidney. Once in position, heat energy is delivered to the abnormal area in the form of radiofrequency waves. Sometimes the needle will have to be repositioned as multiple treatments may be necessary. Heat destroys and eventually shrinks the area of suspected or confirmed cancer.
Benefits
Traditionally, cancer has been treated by a combination of surgery, radiotherapy and chemotherapy. Radiofrequency ablation (RFA) can be considered for suspected or proven kidney (renal) cancer measuring up to 5cm when a patient is assessed not to be fit enough for surgery or if the patient decides for this treatment regardless of their fitness.
There is less risk for significant blood loss with faster recovery times when compared to traditional open surgery. Furthermore, it is less likely to damage blood vessels or the collecting system of the kidney while preserving as much as possible of normal kidney tissue without the need for dialysis or renal transplant.
Risks
Radiofrequency Ablation (RFA) is a safe, effective and accurate procedure, but as with any medical procedure there are some risks and complications that you may uncommonly experience.
Pain: Some patients experience flank pain after the procedure, often described as a dull ache. This can vary from mild to moderate and can be managed with painkillers (analgesia).
Bleeding: Risk of bleeding that is significant is rare. Uncommonly you may get a small bruise at the needle entry point in the flank. Rarely a blood transfusion may be required and an interventional radiological or surgical procedure may be necessary to stop ongoing bleeding.
Infection: The risk of infection is small however to minimise the risk even further, antibiotics will be prescribed and administered prior to the procedure.
Damage to vital structures: This is uncommon and can occur while attempting to navigate the needle into the abnormal tissue area or when delivering the radiofrequency waves as a result of thermal damage (damage to bowel, lung, blood vessels, collecting system of the kidney).
Recurrence: There is a risk of recurrence of the tumour after the procedure. Dr Zertalis will discuss this with you in detail. The exact risk varies from patient to patient and follow-up scans to examine the ablated area will be organised.
Post-Ablation Syndrome: This is an inflammatory response of the body to the procedure and can present as pain, general weakness (fatigue), muscle ache (myalgia), and low-grade fever. This responds well to pain killers such as paracetamol.
Allergy to contrast (X-ray dye): Most adverse events are mild and can be managed safely in our department. A major life-threatening contrast reaction is rare (< 0.005%).
Radiation Risk: Immediate harmful effects such as skin burns, or radiation sickness are extremely rare. The radiation dose you receive during the procedure is monitored to prevent this. On rare occasions the procedure will have to be stopped if the threshold for immediate harmful effects is reached. Increase in lifetime risk of cancer due to radiation per examination is also rare (< 0.001%).
Dr Zertalis will explain the procedure and ask you to sign a consent form. Please feel free to ask any questions that you may have and, remember that even at this stage, you can decide against going ahead with the procedure if you so wish.
Before the procedure
You should have had an extensive discussion with your Urologist and/or Oncologist about your kidney tumour, the various treatment options and the risks and benefits of the RFA procedure. An up-to-date CT and/or MRI scan is essential for planning treatment.
The procedure is performed either with local anaesthetic and sedation or under general anaesthetic. You will be asked not to eat or drink for 6 hours before the procedure. Where necessary a blood test may be required. A short and thin plastic tube (cannula) will be placed into a vein in your arm.
Please let Dr Zertalis know about any medications you take, any allergies you may have and if you previously have had a reaction to the x-ray dye (contrast).
The procedure
You will be asked to change into a hospital gown and lie on your front or on your side. You will have devices attached to your chest, arm and finger to monitor you pulse, blood pressure and oxygen levels. The procedure will be carried out either under a general anaesthetic or using sedation. This is standard for all ablation procedures performed in Cyprus.
The procedure is performed under sterile conditions and Dr Zertalis will wear sterile gowns and gloves. Your skin will be swabbed with antiseptic and you will be covered with sterile drapes.
Following an injection with local anaesthetic, a small cut (incision) is made in the skin and Dr Zertalis will use ultrasound (US) and or computed tomography (CT) to navigate a fine needle into the abnormal area requiring treatment. A biopsy of the area may be taken prior to performing radiofrequency ablation. Sometimes the needle will have to be repositioned as multiple treatments may be necessary.
Every patient is different, however, expect to be in the radiology department for up to 3 hours.
After the procedure
You will be transferred to your ward where your pulse, blood pressure, oxygen levels and the entry site in the groin will be checked by our team at regular intervals. You should expect to be in bed for 6 hours and to stay in hospital for 24 hours. Some patients need to stay longer although this is unlikely.
You will be advised to rest at home for 72 hours. Please discuss driving, return to work and exercise with Dr Zertalis as this varies between patients. Dr Zertalis will organise a follow-up scan (CT or MRI) 6 weeks after the procedure to evaluate response to treatment.
