Department of Surgical Sciences - Radiology, Uppsala University, Uppsala Sweden.
Department of Medical Sciences - Molecular Epidemiology, Uppsala University, Uppsala Sweden.
Acta Radiol. 2021 Sep;62(9):1248-1256. doi: 10.1177/0284185120956281. Epub 2020 Sep 10.
Radiofrequency ablation (RFA) and laparoscopic partial nephrectomy (LPN) are used to treat small renal masses (SRM; ≤4 cm), although there are conflicting results in the changes in creatinine and estimated glomerular filtration rate (eGFR) after treatment. On contrast-enhanced computed tomography (CE-CT) images, the quantity and quality of renal function can be evaluated by calculating the split renal function (SRF).
To compare renal function after RFA or LPN treatment of SRMs through evaluation of the SRF in the affected kidney.
Single T1a renal tumors successfully treated with RFA (n = 60) or LPN (n = 31) were retrospectively compared. The SRF was calculated on pre-treatment CE-CT images and the first follow-up exam after completed treatment. Serum creatinine and eGFR values were collected simultaneously. To compare renal function outcomes, Student's t-test and multivariable linear regression models (adjusted to RFA/LPN treatment, pre-treatment SRF/eGFR, BMI, age, tumor characteristics, and Charlson Comorbidity Index) were used.
SRF was reduced in both groups, although reduction was greater in the LPN group (LPN -5.7%) than in the RFA group (RFA -3.5%; = 0.013). After adjusted analysis, the LPN group still had greater SRF reduction (difference 3.2%, 95% confidence interval 1.3-1.5; = 0.001). There was no difference between groups in the change of creatinine/eGFR after treatment.
Both RFA and LPN are nephron-sparing when treating SRMs. However, in this series, reduction of SRF in the affected kidney was smaller after RFA, having a more favorable preservation of renal function than LPN.
射频消融术（RFA）和腹腔镜部分肾切除术（LPN）用于治疗小肾肿瘤（SRM；≤4cm），但治疗后肌酐和估算肾小球滤过率（eGFR）的变化存在矛盾的结果。在增强 CT（CE-CT）图像上，可以通过计算分肾功能（SRF）来评估肾功能的数量和质量。
通过评估受影响肾脏的 SRF，比较 RFA 或 LPN 治疗 SRM 后的肾功能。
回顾性比较了 60 例成功接受 RFA 治疗和 31 例接受 LPN 治疗的单 T1a 肾肿瘤患者。在治疗前的 CE-CT 图像上计算 SRF，并在完成治疗后的第一次随访检查中进行计算。同时收集血清肌酐和 eGFR 值。为了比较肾功能结果，使用了学生 t 检验和多变量线性回归模型（调整为 RFA/LPN 治疗、治疗前的 SRF/eGFR、BMI、年龄、肿瘤特征和 Charlson 合并症指数）。
两组的 SRF 均减少，但 LPN 组的减少幅度更大（LPN-5.7%比 RFA 组-3.5%；=0.013）。经过调整分析，LPN 组的 SRF 减少幅度仍更大（差异 3.2%，95%置信区间 1.3-1.5；=0.001）。两组治疗后肌酐/eGFR 变化无差异。
RFA 和 LPN 在治疗 SRM 时都是保肾的。然而，在本系列中，RFA 治疗后受影响肾脏的 SRF 减少幅度较小，对肾功能的保护作用优于 LPN。
