Minimal invasive ablation techniques in small renal tumours treatment
Authors:
A. Čermák; D. Pacík
Published in:
Urol List 2012; 10(3): 16-23
Overview
The improvement in imaging methods has led to an increase in renal cancer incidence during a few last years. Most (approximately 70%) tumours localized in renal parenchym are stage T1a tumours and thus considered as small tumours (mean < 4 cm). These tumours are usually found incidentally during tests for other indication. Virtually 100% of patients are asymptomatic (considering renal cancer). Most tumours are diagnosed in lower stage – T1 without metastatic expansion or lymphatic invasion. Surgical treatment is currently recommended as the standard treatment of small renal masses (SRM). Where technically feasible nephron-sparing resection (partial nephrectomy) is also recommended. Laparoscopic resection represents an alternative to open surgery, but should only be reserved for experienced surgeons. Alternative, minimal invasive methods and conservative treatment can be indicated in selected patients, usually patients with comorbidities in whom surgical treatment would pose significant threat, or patients with short expected survival. The aim of alternative ablation techniques in patients with SRM is to decrease intraoperative morbidity. Percutaneous biopsy is performed to obtain material for histological examination and to select the most adequate treatment modality. Active surveillance should be reserved for patients with significant comorbidities and short expected survival.
Key words:
renal cancer, small renal masses, thermal ablation, cryoablation, interstitial photon radiation ablation therapy, laser ablation, irreversible electrovaporation, microwave therapy
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