Abstract

Purpose: To evaluate feasibility, safety and efficacy of image-guided thermal ablations associated with retrograde pyeloperfusion in patients with centrally located renal tumors.

Materials and methods: 48 patients (15 women, 33 men, mean age 69.1 ± 11.8) were treated with image-guided thermal ablation associated with pyeloperfusion for 58 centrally located renal tumors (mean diameter 32.3 ± 7.32 mm). 7 patients had a single kidney. Microwave and radiofrequency ablation were used. All treatments were performed with ultrasound, CT, or fusion imaging guidance under general anesthesia and simultaneous retrograde cold pyeloperfusion technique.

Results: Procedure was feasible in all cases. Technical success and primary technical efficacy were reached in 51/58 (88%) and 45/54 tumors (83%). With a second ablation performed in 5 tumors, secondary technical efficacy was achieved in 50/50 (100%) tumors. Minor and major complications occurred in 8/58 (13%) and 5/58 (8%) tumors. No significative change in renal function occurred after treatment.

During follow-up, 5 recurrences occurred, that were retreated with a second ablation. At last follow up (mean 32.2 ± 22.0 months), 41/48 (85%) treated patients were free from disease. The median TTP and PFS were 27.0 (range, 2.3–80.0) and 26.5 months (range, 2.3–80.0), respectively.

Conclusion: Image-guided thermal ablation associated with protective pyeloperfusion is a feasible, safe, and effective treatment option for patients with central renal tumors with a minimal impact on renal function and relevant potential to avoid nephrectomy.

摘要

目的：评估在肾脏肿瘤位于中心的患者中，影像引导热消融与逆行肾盂灌注术相关的可行性，安全性和有效性。

材料和方法：对48例位于中心位置的肾肿瘤患者，采用影像引导热消融和肾盂灌注术治疗了48例患者（15例女性，33例男性，平均年龄69.1±11.8）。7名患者只有一个肾脏。使用了微波和射频消融。所有治疗均在全身麻醉和同时逆行冷热输注术的情况下，在超声，CT或融合成像指导下进行。

结果：程序在所有情况下都是可行的。在51/58（88％）和45/54肿瘤（83％）中达到了技术成功和主要技术疗效。在5个肿瘤中进行第二次消融后，在50/50（100％）肿瘤中达到了二级技术功效。次要和主要并发症发生在8/58（13％）和5/58（8％）肿瘤中。治疗后肾功能无明显变化。

在随访期间，发生了5次复发，并再次消融治疗。在最后一次随访中（平均32.2±22.0个月），接受治疗的41/48名患者（85％）没有疾病。TTP和PFS的中位数分别为27.0（范围2.3-80.0）和26.5个月（范围2.3-80.0）。

结论：影像引导热消融与保护性肾盂灌注术对于中心性肾肿瘤患者是一种可行，安全且有效的治疗选择，对肾功能的影响最小，并且具有避免肾切除术的相关潜力。