Mohapatra Anand, Potretzke Aaron M, Weaver John, Anderson Barrett G, Vetter Joel, Figenshau Robert S
Department of Urology, UPMC, Pittsburgh, PA, USA.
Department of Urology, Mayo Clinic, Rochester, MN, USA.
J Kidney Cancer VHL. 2017 Jul 20;4(3):10-19. doi: 10.15586/jkcvhl.2017.82. eCollection 2017.
Treatment modalities for small renal masses (SRMs) include open or minimally invasive radical or partial nephrectomy, and laparoscopic or percutaneous ablations. Members of the Endourological Society were surveyed to evaluate how practitioner and clinical practice characteristics may be associated with the management of SRMs over time. The survey assessed characteristics of urologists (recency of residency and fellowship training, clinical practice type and location, and treatment modalities available) and their management of SRMs over the past year and over the course of the year 5 years prior. Of the 1495 surveys e-mailed, there were 129 respondents (8.6%). Comparing the past year to 5 years prior, there was increasing utilization of robotic partial nephrectomy (p < 0.001) and robotic radial nephrectomy (p = 0.031). In contrast, there was decreasing utilization of open partial nephrectomy (p < 0.001), open radical nephrectomy (p = 0.039), laparoscopic partial nephrectomy (p = 0.002), and laparoscopic radical nephrectomy (p = 0.041). Employment of laparoscopic ablation decreased (p = 0.001), but that of percutaneous ablation did not change significantly. For masses treated with image-guided therapy, there was increasing utilization of microwave ablation (p = 0.008) and decreasing usage of radiofrequency ablation (p = 0.002). Future studies should focus on the most effective treatment modalities based on provider, patient, and tumor characteristics.
小肾肿块（SRMs）的治疗方式包括开放性或微创性根治性或部分肾切除术，以及腹腔镜或经皮消融术。对腔内泌尿外科协会的成员进行了调查，以评估从业者和临床实践特征如何随时间与小肾肿块的管理相关联。该调查评估了泌尿外科医生的特征（住院医师和研究员培训的近期情况、临床实践类型和地点以及可用的治疗方式）以及他们在过去一年和五年前这一年中小肾肿块的管理情况。在通过电子邮件发送的1495份调查问卷中，有129名受访者（8.6%）。将过去一年与五年前进行比较，机器人辅助部分肾切除术（p < 0.001）和机器人辅助根治性肾切除术（p = 0.031）的使用率有所增加。相比之下，开放性部分肾切除术（p < 0.001）、开放性根治性肾切除术（p = 0.039）、腹腔镜部分肾切除术（p = 0.002）和腹腔镜根治性肾切除术（p = 0.041）的使用率在下降。腹腔镜消融术的应用减少（p = 0.001），但经皮消融术的应用没有显著变化。对于接受图像引导治疗的肿块患者，微波消融术的使用率增加（p = 0.008），而射频消融术的使用率下降（p = 0.002）。未来的研究应基于医疗服务提供者、患者和肿瘤特征，聚焦于最有效的治疗方式。
