From the Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (A.C., N.G., W.M.L., M.W.B.); Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Dr 1C352, Bethesda, MD 20892 (S.S., F.H., E.C.J., A.A.M.); and Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (P.B.S.).
Radiographics. 2023 Jul;43(7):e220196. doi: 10.1148/rg.220196.
The two primary nephron-sparing interventions for treating renal masses such as renal cell carcinoma are surgical partial nephrectomy (PN) and image-guided percutaneous thermal ablation. Nephron-sparing surgery, such as PN, has been the standard of care for treating many localized renal masses. Although uncommon, complications resulting from PN can range from asymptomatic and mild to symptomatic and life-threatening. These complications include vascular injuries such as hematoma, pseudoaneurysm, arteriovenous fistula, and/or renal ischemia; injury to the collecting system causing urinary leak; infection; and tumor recurrence. The incidence of complications after any nephron-sparing surgery depends on many factors, such as the proximity of the tumor to blood vessels or the collecting system, the skill or experience of the surgeon, and patient-specific factors. More recently, image-guided percutaneous renal ablation has emerged as a safe and effective treatment option for small renal tumors, with comparable oncologic outcomes to those of PN and a low incidence of major complications. Radiologists must be familiar with the imaging findings encountered after these surgical and image-guided procedures, especially those indicative of complications. The authors review cross-sectional imaging characteristics of complications after PN and image-guided thermal ablation of kidney tumors and highlight the respective management strategies, ranging from clinical observation to interventions such as angioembolization or repeat surgery. and Quiz questions for this article are available in the Online Learning Center. See the invited commentary by Chung and Raman in this issue.
两种主要的保肾干预措施，用于治疗肾细胞癌等肾肿瘤，分别是外科部分肾切除术（PN）和影像引导经皮热消融。保肾手术，如 PN，一直是治疗许多局限性肾肿瘤的标准治疗方法。尽管罕见，但 PN 可能会引起从无症状和轻微到有症状和危及生命的并发症。这些并发症包括血管损伤，如血肿、假性动脉瘤、动静脉瘘和/或肾缺血；集合系统损伤导致尿漏；感染；和肿瘤复发。任何保肾手术后并发症的发生率取决于许多因素，例如肿瘤与血管或集合系统的接近程度、外科医生的技能或经验以及患者的具体情况。最近，影像引导经皮肾消融术已成为治疗小肾肿瘤的一种安全有效的治疗选择，其肿瘤学结果与 PN 相当，且主要并发症的发生率较低。放射科医生必须熟悉这些手术和影像引导程序后的影像学表现，特别是那些提示并发症的影像学表现。作者回顾了 PN 和影像引导肾肿瘤热消融术后的并发症的影像学特征，并强调了各自的管理策略，从临床观察到血管栓塞或再次手术等干预措施。 本文章的测验问题可在在线学习中心找到。见本期 Chung 和 Raman 的特邀评论。
