Klatte Tobias, Kroeger Nils, Zimmermann Uwe, Burchardt Martin, Belldegrun Arie S, Pantuck Allan J
Department of Urology, Medical University of Vienna, Vienna, Austria.
World J Urol. 2014 Jun;32(3):597-605. doi: 10.1007/s00345-014-1284-7. Epub 2014 Apr 4.
Currently, most of renal tumors are small, low grade, with a slow growth rate, a low metastatic potential, and with up to 30 % of these tumors being benign on the final pathology. Moreover, they are often diagnosed in elderly patients with preexisting medical comorbidities in whom the underlying medical conditions may pose a greater risk of death than the small renal mass. Concerns regarding overdiagnosis and overtreatment of patients with indolent small renal tumors have led to an increasing interest in minimally invasive, ablative as an alternative to extirpative interventions for selected patients.
To provide an overview about the state of the art in radiofrequency ablation (RFA), high-intensity focused ultrasound, and cryoablation in the clinical management of renal cell carcinoma.
A PubMed wide the literature search of was conducted.
International consensus panels recommend ablative techniques in patients who are unfit for surgery, who are not considered candidates for or elect against elective surveillance, and who have small renal masses. The most often used techniques are cryoablation and RFA. These ablative techniques offer potentially curative outcomes while conferring several advantages over extirpative surgery, including improved patient procedural tolerance, faster recovery, preservation of renal function, and reduction in the risk of intraoperative and postsurgical complications. While it is likely that outcomes associated with ablative modalities will improve with further advances in technology, their application will expand to more elective indications as longer-term efficacy data become available.
Ablative techniques pose a valid treatment option in selected patients.
目前，大多数肾肿瘤体积小、分级低、生长缓慢、转移潜能低，最终病理检查显示高达30%的此类肿瘤为良性。此外，这些肿瘤常被诊断于患有基础疾病的老年患者中，对于这些患者而言，基础疾病可能比小肾肿块带来更大的死亡风险。对惰性小肾肿瘤患者过度诊断和过度治疗的担忧，已引发人们对微创消融治疗的兴趣日益增加，将其作为部分患者根治性手术的替代方案。
概述射频消融（RFA）、高强度聚焦超声和冷冻消融在肾细胞癌临床治疗中的现状。
在PubMed上进行全面的文献检索。
国际共识小组建议，对于不适合手术、不被视为选择性监测候选者或选择不进行选择性监测且患有小肾肿块的患者，采用消融技术。最常用的技术是冷冻消融和RFA。这些消融技术可提供潜在的治愈效果，同时相对于根治性手术具有多项优势，包括提高患者对手术的耐受性、更快康复、保留肾功能以及降低术中及术后并发症风险。虽然随着技术的进一步发展，消融方式的疗效可能会提高，但随着长期疗效数据的可得，其应用将扩展到更多选择性适应症。
消融技术为部分患者提供了有效的治疗选择。
