Krajewski Wojciech, Guziński Maciej, Tomczak Wojciech, Nowak Łukasz, Łaszkiewicz Jan, Chorbińska Joanna, Chełmoński Adam, Grunwald Katarzyna, Małkiewicz Bartosz, Szydełko Tomasz
Department of Minimally Invasive and Robotic Urology, University Centre of Excellence in Urology, Wroclaw Medical University, Wrocław, Poland.
Department of General Radiology, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wrocław, Poland.
Wideochir Inne Tech Maloinwazyjne. 2024 Oct 25;19(4):483-488. doi: 10.20452/wiitm.2024.17904. eCollection 2024 Dec 27.
The widespread use of ultrasound and cross‑sectional imaging has led to a steady increase in the incidental discovery of renal masses. Most of them are treated with partial nephrectomy (PN), as recommended by the European Association of Urology guidelines. However, this approach carries a risk of local recurrence. In such a case, surgical reintervention can be more challenging and is often associated with worse prognosis. In this context, percutaneous ablative therapies are a promising alternative.
This study presents our experience with using percutaneous cryoablation (PCA) to manage recurrences and new masses in previously operated kidneys.
We conducted a retrospective data analysis to evaluate patients treated with PCA for tumor recurrence or residual disease in the postresection bed, excluding those with de novo or recurrent tumors in the contralateral kidney.
A total of 23 individuals met the inclusion criteria. Of those, 14 initially underwent laparoscopic PN, and 9 were treated with open surgery. The median interval from the initial surgery to recurrence‑targeted PCA was 23 months (range, 7-228). The mean (SD) RENAL score on admission was 7.5 (1.9), and the median (interquartile range) tumor volume was 3 (1.6-4.5) ml. The median length of hospital stay was 23 hours (range, 6-55). There was no significant change in estimated glomerular filtration rate following cryoablation. All the recorded complications, except one, were grade I and resolved with hydration or treatment with nonsteroidal anti‑inflammatory drugs. No patient required dialysis in the perioperative period.
Imaging‑guided PCA is a feasible and effective treatment option for patients with renal tumor recurrences after PN.
超声和横断面成像的广泛应用导致肾脏肿块的偶然发现稳步增加。按照欧洲泌尿外科学会指南的建议，其中大多数采用部分肾切除术（PN）治疗。然而，这种方法存在局部复发的风险。在这种情况下，手术再次干预可能更具挑战性，且往往与更差的预后相关。在此背景下，经皮消融治疗是一种有前景的替代方法。
本研究介绍了我们使用经皮冷冻消融（PCA）治疗既往手术肾脏中的复发灶和新肿块的经验。
我们进行了一项回顾性数据分析，以评估接受PCA治疗肿瘤复发或切除后床残留疾病的患者，排除对侧肾脏有新发或复发肿瘤的患者。
共有23例个体符合纳入标准。其中，14例最初接受了腹腔镜PN，9例接受了开放手术。从初次手术到针对复发进行PCA的中位间隔时间为23个月（范围7 - 228个月）。入院时平均（标准差）RENAL评分为7.5（1.9），中位（四分位间距）肿瘤体积为3（1.6 - 4.5）ml。中位住院时间为23小时（范围6 - 55小时）。冷冻消融后估计肾小球滤过率无显著变化。除1例并发症外，所有记录的并发症均为I级，通过补液或使用非甾体抗炎药治疗得以缓解。围手术期无患者需要透析。
影像引导下的PCA是PN术后肾肿瘤复发患者的一种可行且有效的治疗选择。
