Larrañaga Matías, Ibañez Helga, Pfeifer Jessica, Román Cristobal, Olivares Rubén, Salvadó José Antonio, Cabello José Miguel, Moreno Sergio, Cabello Renato, Franco Carmen, Velasco Alfredo
Urology Intern Program, Faculty of Medicine, Finis Terrae University, Santiago 7501014, Chile.
Urology Resident Program, Faculty of Medicine, Finis Terrae University, Santiago 7501014, Chile.
Curr Oncol. 2025 Apr 23;32(5):246. doi: 10.3390/curroncol32050246.
Radiofrequency is standardized for ablating small renal tumors, but evidence regarding its effects remains limited. Partial nephrectomy, the gold standard, often leads to hemorrhagic complications and irreversible renal damage due to hilum clamping. To mitigate these risks, we propose a novel technique that replaces clamping with radiofrequency ablation of the tumor for hemostasis in robot-assisted partial nephrectomy.
We report on 357 consecutive patients with T1a renal tumors treated with robot-assisted surgery between 2010 and July 2024. Radiofrequency was used peri-tumorally for hemostasis, followed by complete lesion enucleation. Follow-up included ultrasound and creatinine at 1 month, CT scans at months 3 and 9, and then annually for 5 years.
The median age was 60.2 years, with 251 men (70.3%). The median tumor size was 22 mm, and the median blood loss was 15 mL. Hemorrhagic complications occurred in eight patients (2.2%), with one requiring a blood transfusion (0.28%). A total of 30 patients experienced transient stage 1 acute kidney disease (8.4%), with no significant change in median 74.92 mL/min/1.77 m vs. 78.77 mL/min/1.77 m vs. (-value 0.15). The median follow-up was 48.2 months, with no tumor recurrence at the treated site. Renal cell carcinoma was found in 83.7% of tumors.
To our knowledge, this series represent the largest global undertaking of renal tumor treatment using peripheral radiofrequency ablation without clamping, demonstrating optimal surgical and oncological outcomes, lower morbidity, and fewer complications compared to those noted in the revised literature regarding traditional clamping techniques.
射频消融术已被标准化用于治疗小肾肿瘤，但关于其效果的证据仍然有限。作为金标准的部分肾切除术，由于肾门阻断，常导致出血并发症和不可逆的肾损伤。为降低这些风险，我们提出一种新技术，即在机器人辅助部分肾切除术中，用肿瘤射频消融术替代肾门阻断来进行止血。
我们报告了2010年至2024年7月间连续357例接受机器人辅助手术治疗的T1a期肾肿瘤患者。在肿瘤周围使用射频进行止血，随后完整切除肿瘤。随访包括术后1个月的超声和肌酐检查、3个月和9个月的CT扫描，之后每年进行一次，共5年。
患者中位年龄为60.2岁，男性251例（70.3%）。肿瘤中位大小为22mm，中位失血量为15mL。8例患者（2.2%）发生出血并发症，其中1例需要输血（0.28%）。共有30例患者出现短暂的1期急性肾损伤（8.4%），肌酐清除率中位数在术前为74.92mL/min/1.77m²，术后为78.77mL/min/1.77m²，差异无统计学意义（P值0.15）。中位随访时间为48.2个月，治疗部位无肿瘤复发。83.7%的肿瘤为肾细胞癌。
据我们所知，本系列代表了全球最大规模的不进行肾门阻断的外周射频消融治疗肾肿瘤的研究，与传统肾门阻断技术的文献报道相比，显示出最佳的手术和肿瘤学效果、更低的发病率和更少的并发症。
