Probe-ablative nephron-sparing surgery: Cryoablation versus radiofrequency ablation
Probe-ablative nephron-sparing surgery: Cryoablation versus radiofrequency ablation
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DOI：
10.1016/j.urology.2005.12.049
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发表时间：
2006-07-01
期刊：
影响因子：
2.1
通讯作者：
Kaouk, Jihad H.
中科院分区：
文献类型：
--
作者：
Hegarty, Nicholas J.;Gill, Inderbir S.;Kaouk, Jihad H.
在过去的十年中，出现了许多探针消融疗法用于治疗患有局限性肾肿瘤的患者。冷冻消融术和射频消融术（RFA）已得到最详细的研究。我们介绍了在我们机构进行的164例腹腔镜冷冻消融术和82例经皮射频消融术的结果，并在并发症、对肾功能的影响、随访成像和肿瘤结局方面对其进行了回顾性比较。冷冻治疗与RFA的比较显示，平均肿瘤大小相似（2.56 cm vs 2.51 cm）;然而，冷冻消融组的前部肿瘤数量更多（39% vs 10%），中央肿瘤更少（6% vs 37%），孤立肾更少（24% vs 49%）。冷冻消融组和RFA组的平均热治疗时间分别为19.3分钟和32.2分钟。在3名接受冷冻消融的患者（1.8%）和9名接受RFA治疗的患者（11.1%）中观察到肿瘤复发或疾病持续存在的放射学证据。所有患者均已通过重复消融/肾切除术成功治疗，或目前正在观察中。两组的并发症发生率均极低;未观察到对平均血清肌酐水平的显著影响。冷冻治疗后的癌症特异性生存率在中位随访3年时为98%，RFA在中位随访1年时为100%。冷冻消融和RFA是保留发育肾单位的选择。在早期肿瘤控制、肾功能保护和低并发症发生率方面，两种形式的探针消融的早期结果令人鼓舞。长期的肿瘤学数据是必要的，这样才能确定这些治疗方式的真正价值。
Over the past decade, a number of probe ablative therapies have emerged for the treatment of patients with localized renal tumors. Cryoablation and radiofrequency ablation (RFA) have been studied in the greatest detail. We present the results of 164 laparoscopic cryoablations and 82 percutaneous RFAs performed in our institution and compare them retrospectively in terms of complications, impact on renal function, follow-up imaging, and oncologic outcomes. Comparison of cryotherapy versus RFA revealed that mean tumor size was similar (2.56 cm vs 2.51 cm); however, the cryoablation group had a greater number of anteriorly located tumors (39% vs 10%), as well as fewer central tumors (6% vs 37%) and fewer solitary kidneys (24% vs 49%). Mean thermal treatment time was 19.3 minutes versus 32.2 minutes in the cryoablation and RFA groups, respectively. Radiologic evidence of tumor recurrence or persistence of disease was noted in 3 patients (1.8%) who underwent cryoablation and in 9 (11.1%)who were treated with RFA. All of have been successfully treated with repeat ablation/nephrectomy, or they are currently under observation. Complication rates were minimal in both groups; no significant impact on mean serum creatinine levels was noted. Cancer-specific survival following cryotherapy was 98% at a median follow-up of 3 years and 100% for RFA at 1-year median follow-up. Cryoablation and RFA are developmental nephron-sparing options. Early results are encouraging for both forms of probe ablation in terms of early oncologic control, preservation of renal function, and low complication rates. Longer-term oncologic data are necessary so that the true value of these treatment modalities can be determined.