Kutikov Alexander, Kunkle David A, Uzzo Robert G
Department of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA.
Curr Opin Urol. 2009 Mar;19(2):148-53. doi: 10.1097/MOU.0b013e328323f7d7.
Surgical excision remains the standard of care for treatment of localized small renal masses (SRMs). Laparoscopic and percutaneous minimally invasive ablative technologies are being increasingly employed in current urologic practice. We review recent literature regarding focal ablative treatments of SRMs.
Most cryoablations are performed using a laparoscopic approach, whereas radiofrequency ablation (RFA) of the SRM is more commonly administered percutaneously. Pretreatment biopsy is performed more often for lesions treated by cryoablation than RFA with a significantly higher rate of indeterminate or unknown pathology for SRMs undergoing RFA versus cryoablation (P < 0.0001). Currently available data suggest that cryoablation results in lower retreatments (P < 0.0001), less local tumor progressions (P < 0.0001) and may be associated with a decreased risk of metastatic progression compared with RFA. It is unclear whether these differences are a function of the technologies or their application. Given the excellent results reported for active surveillance of the SRM in selected patients, the extent to which focal ablation alters the natural history of SRMs has not yet been established.
Currently, data on the ability of interventions for SRMs to affect the natural history of these masses are lacking. Prospective randomized evaluations of available clinical approaches to SRMs are needed.
手术切除仍然是局限性小肾肿块（SRM）治疗的标准方法。腹腔镜和经皮微创消融技术在当前泌尿外科实践中越来越多地被采用。我们回顾了有关SRM局灶性消融治疗的最新文献。
大多数冷冻消融是通过腹腔镜方法进行的，而SRM的射频消融（RFA）更常经皮进行。与RFA相比，冷冻消融治疗的病变更常进行术前活检，接受RFA的SRM的不确定或未知病理发生率明显高于冷冻消融（P < 0.0001）。目前可得的数据表明，与RFA相比，冷冻消融导致的再次治疗率更低（P < 0.0001），局部肿瘤进展更少（P < 0.0001），并且可能与转移进展风险降低有关。尚不清楚这些差异是技术本身还是其应用的结果。鉴于在部分患者中对SRM进行主动监测报告了出色的结果，局灶性消融改变SRM自然病程的程度尚未确定。
目前，缺乏关于SRM干预措施影响这些肿块自然病程能力的数据。需要对现有的SRM临床治疗方法进行前瞻性随机评估。
