Management of small renal masses: a review
Management of small renal masses: a review
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DOI：
10.1007/s00345-010-0516-8
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发表时间：
2010-06-01
影响因子：
3.4
通讯作者：
Ozsoy, Mehmet
中科院分区：
文献类型：
--
作者：
Remzi, Mesut;Javadli, Elchin;Ozsoy, Mehmet
近年来，肾脏小肿块（SRM）（千分之一货币符号4厘米）被发现更频繁，特别是在老年人和共病患者。SRM的标准治疗是保留肾单位手术（NSS）。能量消融和监测等新技术已被引入。SRM的治疗选择概述，主要基于NSS、冷冻消融、射频消融（RFA）和监测的荟萃分析。NSS是SRM的标准治疗，具有高达97%的极佳癌症特异性生存率。冷冻消融主要在腹腔镜下进行，RFA主要在腹腔镜下进行。治疗前活检常用于冷冻消融（80%），而不常用于RFA（50%）。冷冻消融术的原发性失败率为4.8%，RFA为13%。两种手术的主要并发症发生率均约为5%。基于消融后6个月的活检，非造影剂增强似乎是冷冻消融后的有效替代标记，但不是RFA后的有效替代标记。能量消融后的随访时间太短，无法得出最终结论。监测数据基于少量的回顾性数据，随访不足。随访期间的生长模式与潜在的肿瘤实体无关。SRM的标准治疗仍然是NSS。能量消融应保留给合并症的老年患者，并对老年和体弱患者进行监测。
Recently, small renal masses (SRMs) (a parts per thousand currency sign4 cm) are found more frequently, especially in the elderly and co-morbid patients. Standard treatment for SRMs is nephron-sparing surgery (NSS). New techniques like energy ablation and surveillance have been introduced.Overview of treatment options for SRMs, based mainly on the meta-analyses available for NSS, cryoablation, radio-frequency ablation (RFA), and surveillance.NSS for SRMs is the standard therapy with excellent cancer-specific survival rates up to 97%. Cryoablation was mainly performed laparoscopically, and RFA mainly percutaneously. Pretreatment biopsies were used frequently for cryoablation (80%) and less frequently for RFA (50%). Primary failure rate for cryoablation was 4.8% and for RFA 13%. Major complication rates for both procedures are around 5%. Based on 6-month post-ablative biopsies, non-contrast enhancement seems to be an effective surrogate marker after cryoablation, but not after RFA. Follow-up after energy ablation is too short to draw final conclusion. Data on surveillance are based on small, retrospective data with insufficient follow-up. Growth patterns during follow-up do not correlate with the underlying tumour entity.Standard therapy for SRMs is still NSS. Energy ablation should be reserved for the elderly patients with co-morbidities and surveillance for the elderly and infirm patients.