Krokidis Miltiadis E, Kitrou Panagiotis, Spiliopoulos Stavros, Karnabatidis Dimitrios, Katsanos Konstantinos
The Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK.
The Department of Interventional Radiology, Patras University Hospital, School of Medicine, 26504, Rion, Greece.
Insights Imaging. 2018 Jun;9(3):385-390. doi: 10.1007/s13244-018-0607-4. Epub 2018 Apr 6.
Surgical partial nephrectomy is still considered as the "gold standard" for the definitive management of small malignant renal masses, whereas treatment with image-guided percutaneous ablation is still mainly reserved for those patients who cannot undergo nephron-sparing surgical resection due to advanced age, underlying comorbidities or compromised renal function. Nonetheless, the recent evidence that underlines the long-term oncological equipoise of percutaneous ablation methods with surgical resection in combination with the reduced complication rate and cost supports the use of an image-guided minimally invasive approach as a first-line treatment. The purpose of this review is to offer an overview of the most widely used percutaneous renal ablation treatments (radiofrequency, microwave and cryoablation) with a focus on their main technical aspects and application techniques for curative ablation of small renal cell carcinoma (stage cT1a). The authors also provide a critical narrative of the relevant medical literature with an emphasis on outcomes of comparative effectiveness research, and appraise the percutaneous methods compared to surgery in the context of evidence-based practice and future research studies.
• RCC is a common cancer and is increasingly detected incidentally at early stages. • There is long-term oncological equipoise of percutaneous ablation compared to surgical resection. • Large-scale trials are required to produce Level 1a evidence.
手术部分肾切除术仍被视为小的恶性肾肿块确定性治疗的“金标准”，而影像引导下经皮消融治疗仍主要适用于因高龄、基础合并症或肾功能受损而无法接受保留肾单位手术切除的患者。尽管如此，最近的证据表明，经皮消融方法与手术切除在长期肿瘤学疗效上相当，且并发症发生率和成本更低，这支持将影像引导下的微创方法作为一线治疗。本综述的目的是概述最广泛使用的经皮肾消融治疗方法（射频、微波和冷冻消融），重点关注其主要技术方面以及小肾癌（cT1a期）根治性消融的应用技术。作者还对相关医学文献进行了批判性叙述，重点是比较有效性研究的结果，并在循证实践和未来研究的背景下评估经皮方法与手术的比较。
• 肾癌是一种常见癌症，越来越多地在早期被偶然发现。
• 与手术切除相比，经皮消融在长期肿瘤学疗效上相当。
• 需要大规模试验来产生1a级证据。
