Long J-A, Neuzillet Y, Poissonnier L, Lang H, Paparel P, Escudier B, Rioux-Leclercq N, Correas J-M, Mejean A, Baumert H, Soulié M, Patard J-J
Service d'urologie, CHU de Grenoble, 38043 Grenoble cedex 9, France.
Prog Urol. 2009 Nov;19 Suppl 3:S116-23. doi: 10.1016/S1166-7087(09)73356-1.
The development of ablative techniques in renal oncology has profoundly changed treatment of small renal tumors. The objective of this review of the literature was to assess the arguments for treating localized kidney tumors with these techniques in the elderly patient. The two techniques retained because of their recognized use, for all approaches, are radiofrequency and cryotherapy. The data in the literature report more frequent local recurrence with these techniques than with surgical excision and an advantage to cryotherapy over radiofrequency. There seems to be no difference in terms of metastatic progression. Morbidity is not insignificant, with major complications in slightly less than 10% of cases. Given the need to consider small tumors (<4 cm), the advantage in terms of life expectancy is challenged by series studying active monitoring of the oldest patients who present co-morbidities. At present, the indications should therefore be measured and based on a general assessment of the patient, with particular consideration of the existing co-morbidities so as not to treat a patient while imposing undue complications.
肾肿瘤消融技术的发展深刻改变了小肾肿瘤的治疗方式。这篇文献综述的目的是评估在老年患者中使用这些技术治疗局限性肾肿瘤的依据。由于其公认的适用性，所有方法中保留的两种技术是射频消融和冷冻消融。文献数据显示，与手术切除相比，这些技术导致局部复发的频率更高，且冷冻消融优于射频消融。在转移进展方面似乎没有差异。发病率不容小觑，严重并发症的发生率略低于10%。考虑到需要处理小肿瘤（<4 cm），对于有合并症的老年患者进行主动监测的系列研究对预期寿命方面的优势提出了挑战。因此，目前应谨慎把握适应症，并基于对患者的全面评估，尤其要考虑现有的合并症，以免在治疗患者时带来不必要的并发症。
