治疗原发性肾脏肿块消融术后复发的微创挽救方法

IF 4.5 2区 医学 Q1 ONCOLOGY
Cancers Pub Date : 2025-03-13 DOI:10.3390/cancers17060974
Mohammadreza Askarpour, Alireza Aminsharifi
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引用次数: 0

摘要

目的:热消融已成为小肾肿块(SRMs)的有效、节约肾单元的治疗方法,特别是对于有合并症的患者。然而,肿瘤复发仍然是一个挑战,需要循证方法的抢救管理。这篇综述探讨了微创治疗srm初次消融后复发的结果。方法:根据PRISMA指南,使用Medline数据库进行文献综述。1981年至2024年间发表的研究是根据预定义的PICO标准进行筛选的。纳入的重点是原发性消融治疗后肿瘤复发的患者,他们接受了微创补救性治疗,包括重复消融、腹腔镜/机器人部分或根治性肾切除术或主动监测。提取的数据包括患者人口统计、初始治疗、复发时间、抢救方式和结果。结果:在29项研究的364例患者中,249例(68.4%)接受了再消融,82例(22.5%)接受了腹腔镜/机器人部分或根治性肾切除术,33例(9%)接受了主动监测。249例再消融患者中,179例(71.9%)无疾病迹象,67例(26.9%)复发,3例(1.2%)预后不确定。抢救性微创部分或根治性肾切除术64例,其中63例(98.4%)无复发。在33名接受积极监测的患者中,4人死亡,4人接受手术,25人仍在接受监测,但随访数据有限。结论:微创挽救方式,如再消融和腹腔镜/机器人部分或根治性肾切除术,有效地控制肿瘤复发,尽管存在技术挑战,肿瘤成功率分别为70%和98%。未来直接比较这些模式的研究对于建立打捞管理的标准化方案至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Minimally Invasive Salvage Approaches for Management of Recurrence After Primary Renal Mass Ablation.

Objectives: Thermal ablation has emerged as an effective, nephron-sparing treatment for small renal masses (SRMs), particularly in patients with comorbidities. However, tumor recurrence remains a challenge, necessitating evidence-based approaches for salvage management. This review examines the outcomes of minimally invasive modalities for managing recurrence following the primary ablation of SRMs. Methods: A literature review was conducted using the Medline database, following PRISMA guidelines. Studies published between 1981 and 2024 were screened based on predefined PICO criteria. Inclusion focused on patients with tumor recurrence after primary ablation therapy who underwent minimally invasive salvage treatments including repeat ablation, laparoscopic/robotic partial or radical nephrectomy, or active surveillance. Data extracted included patient demographics, initial treatments, recurrence timelines, salvage modalities, and outcomes. Results: Of 364 patients across 29 studies, 249 (68.4%) underwent re-ablation, 82 (22.5%) were treated with laparoscopic/robotic partial or radical nephrectomy, and 33 (9%) were managed with active surveillance. Among 249 patients with re-ablation, 179 (71.9%) showed no evidence of disease, 67 (26.9%) experienced recurrence, and outcomes were indeterminate in 3 (1.2%). Salvage minimally invasive partial or radical nephrectomy outcomes were available for 64 cases, with 63 (98.4%) showing no recurrence. In 33 patients under active surveillance, 4 died, 4 underwent surgery, and 25 remained under monitoring, though follow-up data were limited. Conclusion: Minimally invasive salvage modalities, such as re-ablation and laparoscopic/robotic partial or radical nephrectomy, effectively manage tumor recurrence, achieving >70% and >98% oncological success, respectively, despite technical challenges. Future studies directly comparing these modalities are essential for establishing standardized protocols for salvage management.

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来源期刊
Cancers
Cancers Medicine-Oncology
CiteScore
8.00
自引率
9.60%
发文量
5371
审稿时长
18.07 days
期刊介绍: Cancers (ISSN 2072-6694) is an international, peer-reviewed open access journal on oncology. It publishes reviews, regular research papers and short communications. Our aim is to encourage scientists to publish their experimental and theoretical results in as much detail as possible. There is no restriction on the length of the papers. The full experimental details must be provided so that the results can be reproduced.
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