Chan A A, Ahrar K, Matin S F
Department of Urology, The University of Texas MD Anderson , Cancer Center, Houston, TX, USA.
Minerva Urol Nefrol. 2011 Sep;63(3):237-50.
We reviewed the use of ablative therapies in the management of renal cell carcinoma. We performed a PubMed search of the English language literature using the keywords "ablation" and "renal carcinoma." Pertinent articles specific to the technologic advancement of ablative therapy and clinical outcomes were selected for review. Intermediate-term oncologic outcomes of cryoablation and radiofrequency ablation are acceptable but are not quite as good as for surgical excision based nearly all on retrospective studies. No randomized studies have been performed comparing excisional and ablative therapies. Careful selection of patients and tumor characteristics results in improved outcomes. Diagnostic biopsy for tissue confirmation is mandatory and should even be considered post therapy after 6-12 months in patients with a concern about recurrence. Ablative therapies are associated with decreased morbidity, less severe complication rates, and excellent preservation of renal function in comparison with surgical excision. The majority of recurrences occur early, but long-term surveillance is required as delayed recurrences are also possible and the long-term oncologic efficacy is not yet established. Ablation can be delivered percutaneously or laparoscopically, and the superiority of one over the other remains controversial. The percutaneous approach is more cost effective and causes less perinephric desmoplasia. Nearly all data on ablation are retrospective and, with few exceptions, from single institutions. Ablative therapy is an appealing option for the management of small renal tumors shown to be renal cell carcinoma on biopsy in patients who are unsuitable candidates for surgical extirpation.
我们回顾了消融治疗在肾细胞癌管理中的应用。我们使用关键词“消融”和“肾癌”在PubMed上检索了英文文献。选择了与消融治疗技术进展和临床结果相关的文章进行综述。冷冻消融和射频消融的中期肿瘤学结果是可以接受的，但几乎所有基于回顾性研究的结果都不如手术切除。尚未进行比较切除和消融治疗的随机研究。仔细选择患者和肿瘤特征可改善结果。组织确认的诊断性活检是必需的，对于担心复发的患者，甚至在治疗后6至12个月也应考虑进行活检。与手术切除相比，消融治疗的发病率降低，并发症发生率较轻，并且肾功能得到了很好的保留。大多数复发发生在早期，但由于可能出现延迟复发且长期肿瘤学疗效尚未确立，因此需要进行长期监测。消融可以通过经皮或腹腔镜进行，两者的优越性仍存在争议。经皮途径更具成本效益，并且引起的肾周纤维组织增生较少。几乎所有关于消融的数据都是回顾性的，并且除了少数例外，都来自单一机构。对于活检显示为肾细胞癌但不适合手术切除的小肾肿瘤患者，消融治疗是一种有吸引力的选择。
