Kidney tumour ablation

Introduction

This leaflet is designed for patients who have been advised to have a kidney ablation procedure as part of the treatment for kidney cancer.

What is a kidney ablation?

A kidney ablation is a procedure where a device is inserted into a tumour within the kidney, and then heat is generated to destroy the tumour tissue. Heat is generated using microwave energy (MWA).

The device is placed into the tumour through a tiny cut in the skin, and guided into place using ultrasound and computed tomography (CT) scanning.

The whole procedure takes place using a local anaesthetic along with sedation. The procedure will be performed in the CT Scanning department.

Why do I need a kidney ablation?

Your doctor has determined that the tumour within your kidney can be most suitably treated with an ablation procedure.

Who has made the decision?

All patients attending for kidney ablation will have been discussed in a multi-disciplinary meeting of specialists, who have recommended kidney ablation as the most suitable option for treatment.

However, you will also have the opportunity for your opinion to be taken into account. If after discussion with your doctors, you do not want the procedure carried out, you can decide against it.

What happens before the procedure?

• Please refer to the pre-assessment instructions for information prior to the procedure
• Do not eat anything 6 hours before your procedure, unless told otherwise.
• Do not drink anything 2 hours before your procedure
• If you need to take medicine, take it with only a sip of water.
• Please bring in a small overnight bag to include your own washing items, sanitary wear, dressing gown and slippers.
• You will be admitted to hospital on the day of the kidney ablation, usually to the day surgery unit.
• You will have a small cannula put into a vein in your arm for painkillers and / or CT contrast.
• Standard blood tests may be carried out.
• If you have any allergies you must let your doctor know.
• If you take any medications to thin the blood (anticoagulants or antiplatelets) please let us know beforehand, as these will need to be stopped a certain length of time before the procedure.
  • Examples include: warfarin, dalteparin, enoxaparin, tinzaparin, dabigatran, rivaroxaban, apixaban, clopidogrel, ticagrelor.
  • Low dose aspirin (75mg) is safe to continue
  • Please discuss with a doctor before stopping any medicines, as sometimes other treatment will need to be given.
• If you have previously reacted to intravenous contrast medium (the dye used for CT scans), you must also tell your doctor about this.

Who will be performing the kidney ablation?

• A specially trained doctor called an interventional radiologist will be performing your kidney ablation.
• Radiologists have special expertise in using ultrasound and CT equipment and in interpreting the images produced.
• They will look at these images while carrying out the procedure.
• The radiologist will be assisted by a radiographer and nurses.

What happens during the kidney ablation?

• You will be asked to change into a hospital gown.
• The procedure is performed laying on your front or side, pillows will be provided to ensure you are comfortable.
• The procedure is performed under local anaesthetic. You will be given a sedative and pain relief during the procedure.
• You will have your observations monitored during the procedure by the nursing team. You may be given additional oxygen to help with your breathing if required.
• Using ultrasound and CT guidance, the ablation device is guided into the tumour, the tumour is then burned with microwave energy.
• Sometimes the ablation device is inserted more than once, depending on the number and size of tumours being treated.
• You will then be transferred back to the ward for recovery.

Will the kidney ablation hurt?

• The operation is performed under local anaesthetic with sedation and pain relief, so you will feel minimal pain during the procedure.
• Afterwards you can sometimes have some discomfort. Please tell a nurse so they can give you pain relief if necessary.

How long does the kidney ablation take?

• Every patient’s situation is different, and it is not always easy to predict how complex or how straightforward the procedure will be.
• Generally, the procedure will last approximately one hour.

What will happen after the kidney ablation?

• You will be taken back to your ward.
• Nursing staff may carry out routine observations including taking your pulse and blood pressure and will also check the treatment site.
• If you experience pain or sickness let the nursing staff know.
• You will need to stay in bed for six hours after the kidney ablation.
• You will usually need to stay in hospital overnight, unless your doctors have told you beforehand you can be discharged on the same day.
• You will need someone to pick you up and take you home.
• You must not drive or use public transport to get home.
• You will need a responsible adult at home with you for the night following the procedure (important if a day-case procedure).
• After the kidney ablation, you will need a follow-up CT scan in three months, in order to assess the response to the treatment. Further treatment may be recommended depending on the scan results.
• A telephone consultation will be arranged by the referring clinician

What are the benefits?

• The purpose of the kidney ablation is to destroy the tumour within the kidney, without causing too much damage to the surrounding tissues. It is potentially curative for tumours that are only within the kidney.
• Generally kidney ablation is much safer and less damaging than open surgery, and may be suitable in situations where surgery is impossible.

What are the risks?

• Kidney ablation is generally a safe procedure, but as with any procedure there are risks.
• Most patients will feel tired following the procedure, often with flu-like symptoms. This is known as post ablation syndrome. These symptoms should settle over one to two weeks. If you are getting worsening fevers you should contact your doctors, as it may indicate an infection within the kidney.
• There is a small chance of bleeding from the kidney after the procedure. This may require further imaging or intervention to stop any bleeding.
• Due to the destruction of the tumour and the immediate surrounding area, there is a small chance of making the existing kidney function worse.
• The ablation device may injure organs around the kidney, such as: lungs, bowel, stomach, spleen, liver and pancreas. The exact risk of this depends on where the tumour is and will be explained by your doctor. If another organ is injured this may be serious and require further operations.
• If the tumour is difficult to target during the procedure, then it may not be accurately ablated. This may require repeat ablations on another day.
• If you are having a CT guided ablation, your kidney function may rarely be affected by the contrast dye injected, though this usually recovers.

Radiation Risks

• You have been referred for an Interventional Radiology procedure to help deliver your treatment. A specialist in radiology agrees that this is the best procedure to treat your clinical condition and that the benefit of the examination is greater than the risk.
• The x-ray involves a dose of ionising radiation equivalent to a few months or years of natural background radiation which we are all exposed to every day.
• Ionising radiation can cause cell damage that may turn cancerous however the risk of this happening from your examination is considered low.
• Depending on the length of the procedure, there may also be a small risk of an excess radiation dose to the skin. This may lead to short term and long term effects (e.g. reddening of the skin and burns).
• If this happens as a result of this procedure, you will receive further advice following the procedure. The dose delivered will be kept as low as is practicable.
• For further information please visit our Imaging-radiology page.

Conclusion

Some of your questions about your kidney ablation should have been answered by this leaflet, but remember this is only a starting point for discussion about your treatment with the doctors looking after you.

Medication

Bring all of your medicines (including inhalers, injections, creams, eye drops or patches) and a current repeat prescription from your GP

Please tell the ward staff about all of the medicines you use. During your stay If you wish to take your medication yourself (self-medicate) please speak with your nurse. Pharmacists visit the wards regularly and can help with any medicine queries.

My Chart

We would encourage you to sign up for MyChart. This is the electronic patient portal at Cambridge University Hospitals that enables patients to securely access parts of their health record held within the hospital’s electronic patient record system (Epic). It is available via your home computer or mobile device

More information is available on our website: My Chart

Contacts/Further information

CT Scanning Department 01223 217219

References/ Sources of evidence

This document has been adapted from one prepared by the British Society of Interventional Radiology (BSIR).