Division of Urology, Virginia Commonwealth University (VCU) Health, Richmond, VA, USA -
Unit of Urology, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy -
Minerva Urol Nephrol. 2023 Feb;75(1):66-72. doi: 10.23736/S2724-6051.22.05092-3. Epub 2022 Oct 26.
Ablative techniques emerged as effective alternative to nephron-sparing surgery for treatment of small renal masses. Radiofrequency ablation (RFA) and cryoablation (CRYO) are the two guidelines-recommended techniques. Microwave ablation (MWA) represents a newer technology, less described. The aim of the study was to compare outcomes of MWA to those of CRYO and RFA.
Retrospective investigation of patients who underwent MWA, CRYO, or RFA from seven high-volume US and European centers was performed. The first group included patients who underwent CRYO or RFA; the second MWA. We collected baseline characteristics, clinical, intraoperative, and postoperative data. Oncological data included technical success, local recurrence, and progression to metastasis. Multivariate analysis was performed to find predictors for postoperative complications. A composite outcome of "trifecta" was used to assess surgical, functional, and oncological outcomes.
739 patients underwent CRYO or RFA and 50 MWA. CRYO/RFA group had significantly longer operative time (P<0.001), but no difference in LOS, postprocedural Hb mean, intraprocedural complications (P=0.180), overall postprocedural complication rates (P=0.126), and in the 30-day re-admission rate (P=0.853) were detected. No predictive parameter of postprocedural complications was found. Concerning functional outcome, no differences were detected in terms of eGFR at 1 year (P=0.182), ΔeGFR at 1 year (P=0.825) and eGFR at latest follow-up (P=0.070). "Technical success" was achieved in 98.6% of the cases (MWA=100%, CRYO/RFA=98.5%; P=0.775), and there was no significant difference in terms of 2-year recurrence rate (P=0.114) and metastatic progression (P=0.203). Trifecta was achieved in 73.0% of CRYO/RFA vs. 69.6% of MWA cases (P=0.719).
MWA is a safe and effective treatment option for small renal masses. Compared with CRYO/RFA, it seems to offer low complication rates, shorter operation time, and equivalent surgical and functional outcomes.
消融技术已成为治疗小肾肿瘤的保肾手术的有效替代方法。射频消融（RFA）和冷冻消融（CRYO）是两种指南推荐的技术。微波消融（MWA）是一种较新的技术，描述较少。本研究旨在比较 MWA 与 CRYO 和 RFA 的结果。
对来自 7 个美国和欧洲大容量中心的接受 MWA、CRYO 或 RFA 的患者进行回顾性研究。第一组包括接受 CRYO 或 RFA 的患者；第二组接受 MWA。我们收集了基线特征、临床、术中及术后数据。肿瘤学数据包括技术成功率、局部复发和转移进展。进行多变量分析以寻找术后并发症的预测因素。使用“三联征”复合结果来评估手术、功能和肿瘤学结果。
739 例患者接受了 CRYO 或 RFA 治疗，50 例接受了 MWA 治疗。CRYO/RFA 组的手术时间明显较长（P<0.001），但 LOS、术后平均血红蛋白、术中并发症（P=0.180）、总体术后并发症发生率（P=0.126）和 30 天再入院率（P=0.853）无差异。未发现术后并发症的预测参数。在功能结果方面，1 年时 eGFR（P=0.182）、1 年时 ΔeGFR（P=0.825）和最新随访时 eGFR（P=0.070）无差异。98.6%的病例（MWA=100%，CRYO/RFA=98.5%；P=0.775）达到“技术成功”，2 年复发率（P=0.114）和转移性进展率（P=0.203）无显著差异。CRYO/RFA 组三联征达到 73.0%，MWA 组达到 69.6%（P=0.719）。
MWA 是治疗小肾肿瘤的一种安全有效的治疗选择。与 CRYO/RFA 相比，MWA 似乎具有较低的并发症发生率、较短的手术时间以及相当的手术和功能结果。
