Systematic review of perioperative and quality-of-life outcomes following surgical management of localised renal cancer

UCAN Cancer Charity (www.ucanhelp.org.uk) and MacMillan Cancer Charity (www.macmillan.org.uk) helped design and conduct the study.Peer reviewedPostprin

Renal ablation: current management strategies and controversies

Percutaneous image-guided renal ablation provides minimally invasive and safe treatment to small renal cell carcinomas (RCCs) whilst preserving renal function. In addition, it achieves similar oncologic outcomes as surgery. This article aims to outline an overview of the current types of ablative technology, present the current evidence and discuss controversies on image-guided renal ablation

Percutaneous ablation techniques for renal cell carcinoma: current status and future trends

Percutaneous ablation is an increasingly applied technique for the treatment of localized renal tumors, especially for elderly or co-morbid patients, where co-morbidities increase the risk of traditional nephrectomy. Ablative techniques are technically suited for the treatment of tumors generally not exceeding 4 cm, which has been set as general consensus cutoff and is described as the upper threshold of T1a kidney tumors. This threshold cutoff is being challenged, but with still limited evidence. Percutaneous ablation techniques for the treatment of renal cell carcinoma (RCC) include radiofrequency ablation, cryoablation, laser or microwave ablation; the main advantage of all these techniques over surgery is less invasiveness, lower complication rates and better patient tolerability. Currently, international guidelines recommend percutaneous ablation either as intervention for frail patients or as a first line tool, provided that the tumor can be radically ablated. The purpose of this article is to describe the basic concepts of percutaneous ablation in the treatment of RCC. Controversies concerning techniques and products and the need for patient-centered tailored approaches during selection among the different techniques available will be discussed

Početna iskustva u usporedbi CT-vođene radiofrekventne i mikrovalne ablacije u terapiji karcinoma bubrega

Percutaneous ablative techniques under imaging guidance have become a frequently used treatment method in the therapy of primary T1a or secondary renal tumours, especially in patients who were burdened with comorbidities and are not surgical candidates. Radiofrequency ablation with single or multiple electrodes has been the primary ablative technique used and the mainstay of percutaneous therapy for a long time but with the evolution of technologies, microwave ablation and cryoablation have emerged as possibly more effective methods of treatment. After the initial experience with CT-guided radiofrequency ablation for renal carcinoma treatment in 6 patients, we started using microwave ablation with the following 6 patients. Our results showed microwave ablation to have bett er results in achieving complete tumour ablation, while requiring shorter hospitalization time and better patient satisfaction. There have not been any major complications, while minor complications were more frequent with microwave ablation. Due to shorter procedure time patients treated with microwave ablation, we no longer used general anaesthesia but only local anaesthetic with conscious sedation.Perkutane ablativne tehnike pod kontrolom slikovnih metoda su postale često korištena metoda u terapiji primarnih tumora bubrega T1a stadija ili sekundarnih bubrežnih tumora, ponajprije kod pacijenata koji zbog komorbiditeta nisu primarno kirurški kandidati. Radiofrekventna ablacija s jednom ili više elektroda je bila prva korištena ablativna metoda i dugo vremena glavna okosnica perkutane terapije, no s razvojem novih tehnologija, mikrovalna ablacija i krioablacija su se pojavile kao potencijalno učinkovitije opcije liječenja. Nakon početnih iskustava s CT-vođenom radiofrekventnom ablacijom karcinoma bubrega kod šest pacijenata, započeli smo koristiti mikrovalnu ablaciju kod idućih šest pacijenata. Naši rezultati su pokazali da s mikrovalnom ablacijom postižemo bolje rezultate u smislu potpune ablacije tumora uz kraće potrebno vrijeme hospitalizacije i veću razinu zadovoljstva pacijenata nakon zahvata. Nisu zabilježene veće komplikacije, dok su manje komplikacije bile učestalije nakon mikrovalne ablacije. Pacijenti tretirani mikrovalnom ablacijom nisu zahtijevali opću anesteziju zbog kraćeg vremena ablacije

Small renal carcinoma : the "when" and "how" of operation, active surveillance, and ablation

Small, locally restricted renal cell carcinoma less than 4 cm in size should ideally be removed operatively by nephron-sparing tumour enucleation (partial kidney resection). In an increasingly elderly population, there is a growing trend toward parallel incidence of renal cell carcinoma and chronic renal insufficiency, with the latter's associated general comorbidities. Thus, for some patients, the risks of the anaesthesia and operation increase, while the advantage in terms of survival decreases. Transcutaneous radio-frequency ablation under local anaesthesia, transcutaneous afterloading high-dose-rate brachytherapy under local anaesthesia, and percutaneous stereotactic ablative radiotherapy may offer a less invasive alternative therapy. Active surveillance is to be regarded as no more than a controlled bridging up to definitive treatment (operation or ablation), while watchful waiting, on account of the lack of prognostic relevance and the symptomatology of renal cell carcinoma, with its comorbidity-related, clearly reduced life expectancy, does not involve any further diagnostic or therapeutic measures

Microwave ablation of renal tumors: state of the art and development trends

In the last decades an increased incidence of new renal tumor cases has been for clinically localized, small tumors <2.0 cm. This trend for small, low-stage tumors is the reflection of earlier diagnosis primarily as a result of the widespread and increasing use of non-invasive abdominal imaging modalities such as ultrasound, computerized tomography, and magnetic resonance imaging. Renal tumors are often diagnosed in elderly patients, with medical comorbidities whom the risk of surgical complications may pose a greater risk of death than that due to the tumor itself. In these patients, unsuitable for surgical approach, thermal ablation represents a valid alternative to traditional surgery. Thermal ablation is a less invasive, less morbid treatment option thanks to reduced blood loss, lower incidence of complications during the procedure and a less long convalescence. At present, the most widely used thermal ablative techniques are cryoablation, radiofrequency ablation and microwave ablation (MWA). MWA offers many benefits of other ablation techniques and offers several other advantages: higher intratumoral temperatures, larger tumor ablation volumes, faster ablation times, the ability to use multiple applicators simultaneously, optimal heating of cystic masses and tumors close to the vessels and less procedural pain. This review aims to provide the reader with an overview about the state of the art of microwave ablation for renal tumors and to cast a glance on the new development trends of this technique

Management of Residual or Recurrent Disease Following Thermal Ablation of Renal Cortical Tumors

Management of residual or recurrent disease following thermal ablation of renal cortical tumors includes surveillance, repeat ablation, or surgical extirpation. We present a multicenter experience with regard to the management of this clinical scenario. Prospectively maintained databases were reviewed to identify 1265 patients who underwent cryoablation (CA) or radiofrequency ablation (RFA) for enhancing renal masses. Disease persistence or recurrence was classified into one of the three categories: (i) residual disease in ablation zone; (ii) recurrence in the ipsilateral renal unit; and (iii) metastatic/extra-renal disease. Seventy seven patients (6.1%) had radiographic evidence of disease persistence or recurrence at a median interval of 13.7 months (range, 1–65 months) post-ablation. Distribution of disease included 47 patients with residual disease in ablation zone, 29 with ipsilateral renal unit recurrences (all in ablation zone), and one with metastatic disease. Fourteen patients (18%) elected for surveillance, and the remaining underwent salvage ablation (n = 50), partial nephrectomy (n = 5), or radical nephrectomy (n = 8). Salvage ablation was successful in 38/50 (76%) patients, with 12 failures managed by observation (3), tertiary ablation (6), and radical nephrectomy (3). At a median follow-up of 28 months, the actuarial cancer-specific survival and overall survival in this select cohort of patients was 94.8 and 89.6%, respectively