The two primary nephron-sparing interventions for treating renal masses such as renal cell carcinoma are surgical partial nephrectomy (PN) and image-guided percutaneous thermal ablation. Nephron-sparing surgery, such as PN, has been the standard of care for treating many localized renal masses. Although uncommon, complications resulting from PN can range from asymptomatic and mild to symptomatic and life-threatening. These complications include vascular injuries such as hematoma, pseudoaneurysm, arteriovenous fistula, and/or renal ischemia; injury to the collecting system causing urinary leak; infection; and tumor recurrence. The incidence of complications after any nephron-sparing surgery depends on many factors, such as the proximity of the tumor to blood vessels or the collecting system, the skill or experience of the surgeon, and patient-specific factors. More recently, image-guided percutaneous renal ablation has emerged as a safe and effective treatment option for small renal tumors, with comparable oncologic outcomes to those of PN and a low incidence of major complications. Radiologists must be familiar with the imaging findings encountered after these surgical and image-guided procedures, especially those indicative of complications. The authors review cross-sectional imaging characteristics of complications after PN and image-guided thermal ablation of kidney tumors and highlight the respective management strategies, ranging from clinical observation to interventions such as angioembolization or repeat surgery. Work of the U.S. Government published under an exclusive license with the RSNA. Online supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article. Quiz questions for this article are available in the Online Learning Center. See the invited commentary by Chung and Raman in this issue.
Radiographics : a review publication of the Radiological Society of North America, Inc. 2023 Jul [Epub]
Aditi Chaurasia, Shiva Singh, Fatemeh Homayounieh, Nikhil Gopal, Elizabeth C Jones, W Marston Linehan, Paul B Shyn, Mark W Ball, Ashkan A Malayeri
From the Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (A.C., N.G., W.M.L., M.W.B.); Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Dr 1C352, Bethesda, MD 20892 (S.S., F.H., E.C.J., A.A.M.); and Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (P.B.S.).