What Can Go Wrong with RFA therapy?

What Can Go Wrong with RFA therapy?

What Can Go Wrong with RFA therapy?

Image of a very large nodule that was considered too large and had atypically cytology
for RFA.
As various complications can occur during RF ablation,
knowledge of the possible complications and suggested
management.
In a recent multicenter study of 1459 patients,
the complication rate after RF ablation was 3.3% and with a
major complication rate of 1.4% [40].
Pain is the most common patient complaint during
RF ablation, although the pain decreases rapidly when the
generator output is reduced or turned off. Pain is usually selflimited
and few patients complain of intractable pain [17].
Voice change is a serious complication of RF ablation
and is likely due to injuries to the recurrent laryngeal nerve
or hemorrhage. Thermal nerve injury may be prevented by
using the moving shot technique and by undertreating the
conceptual ablation units adjacent to the nerve, which is
known as the danger triangle [15, 17, 19, 22]. Familiarity
with the variations of the vagus nerve, for example, located
adjacent to the thyroid gland, is also helpful in order to
prevent nerve injury [3, 42].
Hematomas can usually be controlled by compressing the
neck for several minutes. Serious perithyroidal hemorrhage
may be prevented by examining the perithyroidal vessels
before inserting the electrode and with the use of smallbore
electrodes [40]. Most hematomas completely disappear
within one or two weeks.
Skin burn, mostly first degree, at the electrode puncture
site is possible, especially when a thyroid nodule is large and
the skin bulges. Skin color changes usually resolve within one
week following the procedure and are without sequelae [18,
40].
Nodule rupture presents with sudden neck bulging and
pain during the follow-up period. It is secondary to the acute
volume expansion of a nodule due to hemorrhage [40]. This
complication can usually be managed conservatively with
antibiotics and/or analgesics.

Comments: Patient selection is major. Spongiform nodules have the best response in shrinkage. Also cytology and molecular marker and classifiers must be negative to be a candidate for RFA. Even when it looks like a good candidate there still is a 3-5% chance it is a cancer needing surgery. Post RFA failure to shrink is a clue the patient needs surgery. Also the extreme size of the nodule makes it less likely to have >50% shrinkage.Also the larger nodules are more likely to be cancer if they don’t shrink.
Richard Guttler Md,FACE,.ECNU

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