Faculty of Medicine, University of Glasgow, Glasgow, UK.
Department of General Surgery, Royal Alexandra Hospital, Paisley, UK.
Urologia. 2022 Aug;89(3):329-337. doi: 10.1177/03915603221077590. Epub 2022 Feb 10.
We review the safety and early oncological outcomes of irreversible electroporation (IRE), a novel non-thermal ablation technique, in small renal masses (SRMs). Following PROSPERO registration (CRD42020197943), a systematic search of MEDLINE, EMBASE and SCOPUS databases according to PRISMA guidelines was performed. Critical appraisal of the included studies was performed using the Newcastle-Ottawa Scale. Of 224 articles screened, 10 met the inclusion criteria. In total, 83 patients were identified. Except for one cohort study ( = 41), the remaining studies were case series of < 10. Follow up was <12 months in 7/10 articles (range 3-34 months). About 10/10 articles reported safety outcomes. There were no 30-day mortalities. The most frequently reported adverse events were transient haematuria (11/83) and asymptomatic perirenal haematomas (7/83). About 62/63 patients with reported length of stay were discharged within 24 h. No significant long-term changes in renal function were reported. About 7/10 articles reported oncological outcomes. Only one article assessed histopathological outcomes, whilst the remaining studies used cross-sectional imaging modalities to assess efficacy, recurrence or disease progression. About 4/7 patients with histopathology outcomes, showed complete response (CR). About 43/55 patients with radiological outcomes showed CR. No mortalities were reported due to SRMs. These initial findings support IRE as safe and feasible in managing SRMs. However, results from larger studies with longer follow-up are needed to evaluate oncological outcomes and compare these with other ablation methods.
我们回顾了不可逆电穿孔（IRE）作为一种新的非热消融技术在小肾肿瘤（SRM）中的安全性和早期肿瘤学结果。在 PROSPERO 注册（CRD42020197943）后，根据 PRISMA 指南对 MEDLINE、EMBASE 和 SCOPUS 数据库进行了系统搜索。使用纽卡斯尔-渥太华量表对纳入研究进行了批判性评价。在筛选出的 224 篇文章中，有 10 篇符合纳入标准。共有 83 例患者入选。除了一项队列研究（ = 41）外，其余研究均为 < 10 例的病例系列研究。10 篇文章中有 7 篇（范围 3-34 个月）的随访时间<12 个月。10/10 篇文章均报道了安全性结果。无 30 天死亡率。最常报告的不良事件是短暂血尿（11/83）和无症状肾周血肿（7/83）。约 62/63 例报告了住院时间的患者在 24 小时内出院。未报告肾功能有明显的长期变化。约 7/10 篇文章报告了肿瘤学结果。只有一篇文章评估了组织病理学结果，而其余研究使用横断面成像模式来评估疗效、复发或疾病进展。在有组织病理学结果的 4/7 例患者中，完全缓解（CR）。在有影像学结果的 43/55 例患者中，CR。未报告因 SRM 而导致的死亡。这些初步结果支持 IRE 在治疗 SRM 方面的安全性和可行性。然而，需要更大规模、随访时间更长的研究来评估肿瘤学结果，并将其与其他消融方法进行比较。
