Management and outcomes of tumor recurrence after focal ablation renal therapy.
Management and outcomes of tumor recurrence after focal ablation renal therapy.
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DOI：
10.1089/end.2009.0658
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发表时间：
2010-05
影响因子：
2.7
通讯作者：
A. Breda;C. Anterasian;A. Belldegrun
中科院分区：
文献类型：
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作者：
A. Breda;C. Anterasian;A. Belldegrun
背景和目的冷冻消融（CA）和射频消融（RFA）已成为小肾脏肿块患者的可行治疗选择。尽管中间肿瘤学结果与手术相当，但复发的治疗仍然存在争议。本综述旨在全面概述局灶性肾脏消融治疗失败后的管理选择和结果。此外，它还介绍了我们机构如何治疗 CA 和 RFA 失败的患者。方法 对 Pub-Med 数据库进行系统回顾，以确定有关肾脏 CA 和 RFA 的文章。使用的关键词是“小肾肿块”、“增强肾肿块”、“冷冻消融”、“射频消融”、“肿瘤复发”、“消融后”、“治疗”、“挽救性肾切除术”、“部分肾切除术”、“腹腔镜检查”和“主动监测”。审查了 1995 年至 2009 年间的英文文章。结果 本次综述共纳入30篇文章；然而，仅找到 6 篇专门涉及本次评论主题的原创文章。如果 CA 或 RFA 失败后肿瘤复发，可行的治疗方案包括主动监测、重复消融和挽救性部分/根治性肾切除术。对于 CA 或 RFA 后早期增强的患者来说，长达 1 年的主动监测似乎是一个安全的选择，因为大部分增强可能来自术后炎症。重复 CA 和 RFA 仍然是消融失败后最常执行的手术，但具有良好的肿瘤学结果。然而，当术后随访中出现明显的肿瘤进展时，就需要进行手术。尽管建议进行部分肾切除术以保留肾功能，但由于初始消融引起的疤痕和纤维化，术中和术后并发症是一个令人担忧的问题。因此，最常首选根治性肾切除术。这可以通过开放或腹腔镜方法进行。结论 当 CA 或 RFA 后怀疑复发时，有不同的选择。本次综述强调，主动监测、再次消融和手术（通常是根治性肾切除术）都是治疗失败消融手术的可行选择。
BACKGROUND AND PURPOSE Cryoablation (CA) and radiofrequency ablation (RFA) have emerged as viable treatment options for patients with small renal masses. Although the intermediate oncologic outcomes are comparable to those of surgery, the management of a recurrence is still controversial. This review intends to provide a comprehensive overview of management options and outcomes after failed focal ablation renal therapy. In addition, it presents how patients in whom CA and RFA fail are treated at our institution. METHODS A systematic review of the Pub-Med database was performed to identify articles on renal CA and RFA. The keywords used were "small renal mass," "enhancing renal mass," "cryoablation," "radiofrequency ablation," "tumor recurrence," "postablation," "management," "salvage nephrectomy," "partial nephrectomy," "laparoscopy," and "active surveillance." English-language articles between 1995 and 2009 were reviewed. RESULTS A total of 30 articles were included in this review; however, only 6 original articles were found that dealt specifically with the theme of this review. In the case of tumor recurrence after failed CA or RFA, viable management options include active surveillance, repeated ablation, and salvage partial/radical nephrectomy. Active surveillance up to 1 year appears to be a safe option in patients with early enhancement after CA or RFA, because the majority of the enhancements may be from postoperative inflammation. Repeated CA and RFA remain the most commonly performed procedures after a failed ablation with excellent oncologic outcomes. When significant tumor progression is present on postoperative follow-up, however, surgery is necessary. Although a partial nephrectomy would be advisable to preserve renal function, intraoperative and postoperative complications are a concern because of scarring and fibrosis from the initial ablation. For this reason, a radical nephrectomy is most commonly preferred. This could be performed through an open or a laparoscopic approach. CONCLUSIONS When a recurrence is suspected after CA or RFA, different options are available. This review has highlighted that active surveillance, reablation, and surgery (usually radical nephrectomy) are all viable options for the management of a failed ablative procedure.