Ultrasound-Guided Percutaneous Thermal Ablation of Renal Cancers-In Search for the Ideal Tumour.
Ultrasound-Guided Percutaneous Thermal Ablation of Renal Cancers-In Search for the Ideal Tumour.
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超声引导下经皮射频消融术是一种相对简单、安全和廉价的治疗方法，适用于小型肾肿瘤患者，因此是此类病例的一种有吸引力的替代方法。然而，据报道，与目前的标准肾部分切除术相比，它与复发风险增加有关。本研究的目的是评估与残留疾病/复发风险增加相关的肿瘤特征，并发现哪些肿瘤可以通过超声引导经皮消融治疗而不会增加复发风险。超声引导下经皮射频消融术安全且耐受性良好。其有效性取决于肿瘤大小，对于小于3 cm的外生病灶效果最佳。大多数复发或残留的肿瘤成功地再次治疗超声引导下经皮消融。近年来，成像技术的进步导致了对肾脏肿瘤（包括肾脏小肿块）的检测增加。虽然手术仍然是护理的标准，但人们对微创方法的兴趣越来越大。超声（US）引导下经皮消融术特别有吸引力，因为它是一种安全且相对简单的手术。在这项研究中，我们研究了经皮射频消融（RFA）的成功率与肾脏肿瘤直径和位置的关系。在2016年8月至2021年9月期间，253名患者的259个肾脏肿瘤接受了超声引导下RFA作为我们机构的主要治疗。共有67例患者被排除在本研究之外。术前进行腹部计算机断层扫描（CT）和肿瘤活检。术后均行CT增强扫描，平均随访28个月。研究组包括186例患者，其中191例肾肿瘤，仅包括活检证实的肾癌。随访中发现46例残留病灶，4例局部进展，肿瘤大小与消融成功率有显著相关性。病变≤ 25 mm的成功率分别为73.5%和87.6%，病变≤ 25 mm和外生性的成功率分别为94.6%，病变26 - 30 mm的成功率分别为79.1%和84.4%。观察到4例Clavien-Dindo ≥ 2级并发症。T1a肾癌的超声引导经皮RFA安全且耐受性良好。其有效性取决于肿瘤大小，对于小于3 cm的外生性病变效果最佳。大多数复发或残留肿瘤可以通过超声引导下经皮RFA成功再治疗。
Ultrasonography-guided percutaneous radiofrequency ablation is a relatively simple, safe and inexpensive treatment method for patients with small renal tumours and thus an attractive alternative in such cases. It has been, however, reported to be associated with an increased risk of recurrence in comparison with the current standard—partial nephrectomy. The aim of this study is to evaluate tumour characteristics associated with an increased risk of residual disease/recurrence and to find which tumours can be treated with ultrasonography-guided percutaneous ablation without an increased risk of recurrence. Ultrasonography-guided percutaneous radiofrequency ablation was safe and well-tolerated. Its effectiveness depended on tumour size, with best results for exophytic lesions smaller than 3 cm. Most of the recurrent or residual tumours were successfully re-treated with ultrasonography-guided percutaneous ablation. Over the recent years, the progress in imaging techniques has led to an increased detection of kidney tumours, including small renal masses. While surgery is still the standard of care, there is a growing interest in minimally invasive methods. Ultrasound (US)-guided percutaneous ablation is particularly attractive because it is a safe and relatively simple procedure. In this study, we investigated the success of percutaneous radiofrequency ablation (RFA) in relation to kidney tumour diameter and location. Between August 2016 and September 2021, 253 patients with 259 renal tumours underwent US-guided RFA as a primary treatment in our institution. A total of 67 patients were excluded from this study. Abdominal computed tomography (CT) and tumour biopsy were performed before the procedure. Patients were followed with contrast-enhanced CT, the average follow-up time was 28 months. The studied group was composed of 186 patients with 191 renal tumours—only biopsy-confirmed renal cancers were included. During the follow-up, 46 cases of residual disease and 4 cases of local progression were found. There was a significant correlation between tumour size and the ablation success rate. The success rate was 73.5% and 87.6% for lesions ≤25 mm, 94.6% for lesions ≤25 mm and exophytic, 79.1% for lesions 26–30 mm and 84.4% for lesions 26–30 mm and exophytic, respectively. Four Clavien-Dindo grade ≥2 complications were observed. US-guided percutaneous RFA of T1a renal cancers is safe and well-tolerated. Its effectiveness depends on tumour size, with best results for exophytic lesions smaller than 3 cm. Most of the recurrent or residual tumours can be successfully re-treated with US-guided percutaneous RFA.
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影响因子：
23.4
作者：
Psutka, Sarah P.;Feldman, Adam S.;Gervais, Debra A.
通讯作者：
Gervais, Debra A.
影响因子：
23.4
作者：
Andrews, Jack R.;Atwell, Thomas;Thompson, R. Houston
通讯作者：
Thompson, R. Houston
DOI：
10.1016/j.urolonc.2012.01.006
发表时间：
2013-10-01
影响因子：
2.7
作者：
Castle, Scott M.;Gorbatiy, Vladislav;Leveillee, Raymond J.
通讯作者：
Leveillee, Raymond J.
影响因子：
6.6
作者：
Johnson, Brett A.;Sorokin, Igor;Cadeddu, Jeffrey A.
通讯作者：
Cadeddu, Jeffrey A.
影响因子：
2.6
作者：
Bianchi, Lorenzo;Chessa, Francesco;Schiavina, Riccardo
通讯作者：
Schiavina, Riccardo