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1.
Background
The incidence of primary liver tumors is rising. Modern minimally invasive, image-guided procedures offer a potentially curative therapy option.Objective
The aim of this study was to evaluate the multitude of image-guided minimally invasive procedures concerning their evidence-based effect on local tumor control and overall survival.Material and methods
A systematic search of MEDLINE focused on hepatocellular cancer, minimally invasive treatment, local ablative therapy, therapeutic stratification and comparative studies was performed.Results
The level of evidence varied greatly depending on the procedure used. The highest quality evidence including prospective randomized studies was found for radiofrequency ablation (RFA) of hepatocellular cancer. The RFA is superior with respect to local tumor control and overall survival in comparison to other ablative procedures. Prospective randomized studies comparing surgery and RFA showed diverging and contradictory results. Microwave ablation and robotic stereotactic irradiation showed sufficient potential in retrospective studies in comparison to RFA and surgery in order to confirm the techniques in randomized studies. There is only anecdotal evidence concerning high intensity focused ultrasound (HIFU) and irreversible electroporation. Percutaneous ethanol injection (PEI), cryoablation and laser-induced thermal therapy (LITT) were inferior techniques to RFA in most studies.Conclusion
Minimally invasive resection and local ablative therapies based on structured imaging and image reporting can improve the prognosis of patients with hepatocellular cancer even in patients that exceed the BCLC 0/A stage.2.
Sasha N. Bhan MD MBA Stephen E. Pautler MD FRCSC Bobby Shayegan MD FRCSC Maurice D. Voss MD MBChB FRACR FRCPC Ron A. Goeree MA John J. You MD MSc FRCPC 《Annals of surgical oncology》2013,20(11):3675-3684
Background
Patients with a cortical small (≤4 cm) renal mass often are not candidates for or choose not to undergo surgery. The optimal management strategy for such patients is unclear.Methods
A decision-analytic Markov model was developed from the perspective of a third party payer to compare the quality-adjusted life expectancy and lifetime costs for 67-year-old patients with a small renal mass undergoing premanagement decision biopsy, immediate percutaneous radiofrequency ablation or percutaneous cryoablation (without premanagement biopsy), or active surveillance with serial imaging and subsequent ablation if needed.Results
The dominant strategy (most effective and least costly) was active surveillance with subsequent cryoablation if needed. On a quality-adjusted and discounted basis, immediate cryoablation resulted in a similar life expectancy (3 days fewer) but cost $3,010 more. This result was sensitive to the relative rate of progression to metastatic disease. Strategies that employed radiofrequency ablation had decreased quality-adjusted life expectancies (82–87 days fewer than the dominant strategy) and higher costs ($3,231–$6,398 more).Conclusions
Active surveillance with delayed percutaneous cryoablation, if needed, may be a safe and cost-effective alternative to immediate cryoablation. The uncertainty in the relative long-term rate of progression to metastatic disease in patients managed with active surveillance versus immediate cryoablation needs to be weighed against the higher cost of immediate cryoablation. A randomized trial is needed directly to evaluate the nonsurgical management of patients with a small renal mass, and could be limited to the most promising strategies identified in this analysis. 相似文献3.
Introduction
The increasing diagnosis of incidental small renal masses has contributed to energy ablative techniques being increasingly utilized as a primary surgical modality. Despite promise associated with thermal ablation, complications related to both cryoablation (CA) and radiofrequency ablations (RFA) do occur. 相似文献4.
Scott M. Castle Michael A. Gorin Vladislav Gorbatiy Raymond J. Leveillee 《World journal of urology》2013,31(5):1105-1110
Purpose
To identify preoperative factors associated with surgical complications and successful diagnostic renal biopsy in both laparoscopic and percutaneous radiofrequency ablation (RFA) of renal masses in order to help aid in preoperative patient counseling for renal RFA.Methods
We reviewed our Institutional Review Board approved database from November 2001 to January 2011, containing 335 tumors treated with either laparoscopic (LRFA) or percutaneous RFA (CTRFA). Preoperative patient demographics, tumor characteristics, and intraoperative surgical data were collected along with biopsy results and clinicopathologic outcomes.Results
RFA was performed on 335 renal tumors (124 LRFA, 211 CTRFA). Non-diagnostic biopsy occurred in 18 (5.5%) tumors. Of the 317 procedures performed, 121 complications occurred in 103 (30.7%) procedures. Multivariate analysis only showed CTRFA (vs LRFA) to increase the likelihood of non-diagnostic biopsy (OR 5.1, 95% CI 1.2–22, p = 0.032). Increased tumor size (p = 0.007) and synchronous ablations (p = 0.019) increased the risk for major complications, while decreased surgeon experience (p = 0.003) and tumors close to the collecting system (p = 0.005) increased the risk of any complication.Conclusions
Preoperative recommendations can be made to patients in the future. We suggest counseling patients that when undergoing RFA, percutaneous approach increases the risk of non-diagnostic biopsy, increased tumor size increases the risk of major complications, having more than 1 tumor ablated increases the risk of a major complication, and tumors close to the collecting system may increase the risk of complications. 相似文献5.
Kyo Chul Koo Hanna Yoo Tae Young Shin Jongchan Kim Young Deuk Choi Koon Ho Rha Won Sik Ham 《World journal of urology》2014,32(1):249-255
Purpose
To confirm predictive accuracies of the RENAL nephrometry score (RNS) nomogram for identifying malignancy and high-grade renal cell carcinoma (RCC) in an external cohort of small renal masses (SRMs).Methods
A total of 1,129 patients who underwent extirpative renal surgery for solid and enhancing cT1 renal tumors between 2005 and 2012 at a single institution were included in the validation cohort. A single uro-radiologist utilized computed tomography image reconstruction to classify tumors according to the RNS. The area under the curve (AUC) and calibration plots were used to determine predictive accuracies of malignancy and high-grade models of the RNS nomogram.Results
Malignant and high-grade tumors were identified in 1,012 (89.6 %) and 389 (38.4 %) patients with cT1 tumors, and in 658 (87.3 %) and 215 (32.6 %) patients with cT1a tumors, respectively. Predictive performances of the nomogram for malignancy and high-grade models revealed AUCs of 0.722 and 0.574 for cT1 tumors, and 0.727 and 0.495 for cT1a tumors, respectively. The predictive value of the malignancy model was comparable to that of the model-development cohort (AUC = 0.76); however, the predictive value of the high-grade model was inferior to that of the model-development cohort (AUC = 0.73).Conclusions
Unlike previous validation studies, we report inferior predictive performance of the RNS nomogram for discriminating high-grade RCC in solid and enhancing SRMs. This suggests that the RNS nomogram may be unreliable for preoperatively predicting high-grade RCC in SRMs, in which tumor size, the key determinant of high-grade RCC, is a limiting factor. 相似文献6.
Ahmed El-Gendi Mohamed El-Shafei Fatma Abdel-Aziz Essam Bedewy 《Journal of gastrointestinal surgery》2013,17(4):712-718
Background
Radiofrequency ablation (RFA) was initially started by radiologists as a percutaneous treatment, but surgeons started to use RFA by surgical approach for patients with tumors at locations difficult for the percutaneous procedure. The aim was to evaluate the results of intraoperative RFA for small hepatocellular carcinomas (HCCs) (<3 cm) in locations difficult for a percutaneous approach.Methods
Two hundred forty-seven patients with small solitary HCC (<3 cm) were treated; 196 via percutaneous RFA while 51 patients presented at sites not amenable for percutaneous route. Twenty-seven out of 51 patients underwent surgical resection, while 24/51 patients underwent intraoperative RFA.Results
The location and depth of the tumor from the liver capsule was the only significant factors in the choice of the surgeon between resection and RFA. RFA was successful in all tumors (complete ablation rate of 100 %). In the surgery group, all patients achieved R0 resection. Complication rate was comparable (p?=?1.0). After a median follow-up of 37 months (range, 10–45 months), no tumors showed neither local progression nor local recurrence and no significant difference was observed between two groups as regards early recurrence and number of de novo lesions (p?=?0.49). One-year and 3-year survival rates were 93 % and 81 %, respectively, in the resection group comparable to the corresponding rates of 92 % and 74 % in the RFA group (p?=?0.9).Conclusion
For small HCC in locations difficult for a percutaneous approach, intraoperative RFA can be an alternative option for deep-seated tumors necessitating more than one segmentectomy achieving similar tumor control, and overall and disease-free survival. 相似文献7.
Justin P. Fox MD Joshua Gustafson MD Mayur M. Desai PhD MPH Minia Hellan MD Thav Thambi-Pillai MD James Ouellette DO 《Annals of surgical oncology》2012,19(12):3677-3686
Background
Radiofrequency ablation (RFA) for the treatment of hepatic tumors has been increasingly used across the United States. Whether treatment-related morbidity has remained low with broader adoption is unclear. We conducted this study to describe in-hospital morbidity associated with RFA for hepatic tumors and to identify predictors of adverse events in a nationally representative database.Methods
Using the 2006?C2009 Nationwide Inpatient Sample, we evaluated all patients aged ??40?years who underwent an elective RFA for primary or metastatic liver tumors (N?=?1298). Outcomes included in-hospital procedure-specific and postoperative complications. Multivariable logistic regression analyses were performed to identify patient and facility predictors of complications.Results
Most patients underwent a percutaneous (39.9?%) or laparoscopic (22.0?%) procedure for metastatic liver tumors (57.5?%). Procedure-specific complications were frequent (18.2?%), with transfusion requirements (10.7?%), intraoperative bleeding (4.3?%), and hepatic failure (2.8?%) being the most common. Arrhythmias [adjusted odds ratio (AOR)?=?1.93 (1.23?C3.04)], coagulopathy [AOR?=?4.65 (2.95?C7.34)], and an open surgical approach [AOR?=?2.77 (1.75?C4.36)] were associated with an increased likelihood of procedure-specific complications, whereas hospital RFA volume ??16/year was associated with a reduced likelihood [AOR?=?0.59 (0.38?C0.91)]. Postoperative complications were also common (12.0?%), with arrhythmias, heart failure, coagulopathy, and open surgical approach acting as significant predictors.Conclusions
In-hospital morbidity is common after RFA for hepatic tumors. While several patient factors are associated with more frequent procedure-specific complications, treatment at hospitals with an annual volume ??16 cases/year was associated with a 41?% reduction in the odds of procedure-specific complications. 相似文献8.
Masahiko Sakoda Shinichi Ueno Satoshi Iino Koji Minami Kei Ando Yota Kawasaki Hiroshi Kurahara Yukou Mataki Kousei Maemura Hiroyuki Shinchi Shoji Natsugoe 《World journal of surgery》2013,37(3):597-601
Background
Surgical radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) is associated with superior oncological outcome in comparison with percutaneous RFA. The present study aimed to retrospectively evaluate the relative perioperative safety and postoperative outcome of the laparoscopic or thoracoscopic approach versus the open approach to RFA for small HCC.Methods
A retrospective analysis was performed in 55 consecutive patients who underwent open (n = 32) or laparoscopic/thoracoscopic (LTS) RFA (n = 23) for primary unresectable HCC between January 2005 and December 2010. Baseline characteristics, survival/recurrence rates, and complications after treatment were compared between the two groups.Results
There was a trend showing that LTS RFA was performed for tumors located in the anterior segment (e.g., segments III, V, VIII). The LTS RFA group had a significantly lower intraoperative blood loss, shorter operative time, and shorter postoperative hospital stay, compared with the open RFA group. No major postoperative complications occurred in patients who underwent LTS RFA. No significant differences in overall survival, recurrence-free survival and local recurrence rates were observed between the two groups.Conclusions
In consideration of operative invasiveness and postoperative recovery, LTS RFA is superior to the open approach in patients with small HCC. Moreover, the surgical outcome did not differ between the two approaches. Laparoscopic/thorascopic RFA can be considered to be a useful procedure for ablation therapy. 相似文献9.
Piper C Pfister D Porres D Mahnken A Brehmer B Heidenreich A 《Der Urologe. Ausg. A》2012,51(4):539-543
Background
Nephron sparing surgery (NSS) represents the recommended treatment of choice in guidelines for T1a and T1b renal tumors. Current data, however, suggest that approximately 60% of patients with T1b tumors are treated by radical nephrectomy.Patients and Methods
We performed a retrospective analysis of 320 patients with renal cell cancer who underwent organ sparing procedures: NSS for renal tumors ≤4?cm (n=196, group 1) and 4.1-7?cm (n=92, group 2) as well as radiofrequency ablation (RFA, n=32, group 3). We analysed the indications, surgical techniques, perioperative complications and oncological outcome of the three groups.Results
There were significant differences between groups 1 and 2 with regard to mean tumor size (2.9?cm versus 8.6?cm, p=0.03), necessity for warm ischemia (15.1% versus 51%, p=0.001), mean time of warm ischemia (3.5?min versus 10.2?min, p=0.002), necessity for endoluminal stenting due to involvement of the renal collecting system (0.5% versus 24.2%, p=0.001) and the number of pT2 (12.7% versus 29.7%, p=0.03) and pT3 tumors (8.7% versus 12%, p=0.05). In group 3 the mean age was 69.2 years and the mean Charlson comorbidity score was 7.7 (range 3-12) as compared to 3.4 (1-6) in groups 1 and 2. After a mean follow-up of 32 (2-71) months, 2 (6.2%) local recurrences developed and 8 patients died, 6 patients due to comorbidities and 2 patients due to metastatic renal cell carcinoma (RCC).Conclusions
Nephron sparing surgery can be safely performed for T1a to T2a renal cell carcinoma with equivalent oncological outcomes as compared to radical nephrectomy. Nephron sparing surgery should represent the standard surgical approach for localized RCCs independent of size and RFA should be reserved for patients with significant comorbidities. 相似文献10.
Venu Chalasani Carlos H. Martinez Darwin Lim Mazen Abdelhady Joseph L. Chin 《Canadian Urological Association journal》2010,4(6):399-402
Objective:
There has been increasing interest in surveillance and ablative techniques for small renal masses (SRM), given the increasing number being diagnosed at smaller sizes. Of the currently available ablative techniques, radiofrequency ablation and cryoablation have been the popular ones. We describe our intermediate-term outcomes with using cryoablation for SRM in patients who were not ideal candidates for partial nephrectomy.Materials and methods:
Nineteen patients treated with cryoablation were included. Patients with renal lesions <4 cm were considered for cryoablation, and all patients were treated between 2002 and 2007. Access was either laparoscopic (transperitoneal) or via open surgical techniques. From 2002 to 2004, the CryoCare System (Endocare, Inc., Irvine, CA) was used, with probe sizes ranging from 3 to 5 mm. Before 2004, the SeedNet system (Galil Medical, Arden Hills, MN) was used, with 17-gauge (1.47 mm) IceRod cryoneedles. Recurrence-free survival (RFS) and overall survival (OS) were calculated using Kaplan Meier methodology.Results:
The mean age was 56.7 years. The mean tumour size was 2.6 cm (range 1.2–4.0 cm). There were no intraoperative or postoperative complications in the 19 patients. One patient has been lost to follow-up; mean follow up was 41.6 months (range 7–84 months) in the cohort. Recurrence, defined as either increase in size of lesion or enhancement on follow-up imaging, was seen in 4 patients. There was 1 non-cancer specific death, and 1 cancer specific death.Conclusions:
The 4-year RFS rate and OS rate were 83.6% and 94.1%, respectively, in patients with SRM who were unsuitable for partial nephrectomy. 相似文献11.
O. Heißler S. Seklehner H. Fellner P. F. Engelhardt A. Chemelli C. Riedl 《Der Urologe. Ausg. A》2018,57(7):828-835
Background
The incidence of small renal masses has increased in recent decades. Standard surgical treatment may not be applicable in patients with advanced age or severe comorbidities. Therefore, minimally invasive therapeutic approaches, such as radiofrequency ablation (RFA), may be a therapeutic option for such patients.Objectives
Assessment of oncological and functional outcomes of percutaneous RFA in small renal masses.Materials and methods
Single center evaluation of all RFA performed at the hospital Landesklinikum Baden from 2006–2016.Results
A total of 98 RFA were performed in 85 patients. Mean patient age was 69.5 years. Median tumor size was 26.2?mm, while the length of hospital stay was 1.4 days. Overall, 96.8% of RFA procedures were considered to be technically complete. Recurrence rate was 17.5%. Most of the recurrences were treated via a second RFA. Complication rates were fairly low as the vast majority of ablations were free of complications (82.7%). Grade I, II and III complications (according to the Clavien-Dindo classification) occurred in 13.3%, 3% and 1%, respectively. A significant deterioration of renal function due to RFA was not observed. Cancer-specific survival rate for renal cell carcinoma was 100%; overall survival was 84.7% after an average follow-up period of more than 3 years.Conclusion
RFA is an adequate alternative treatment option for small renal masses in patients unfit to undergo surgical excision. Patients benefit from the low complication rates, preservation of renal function, and short hospital stays.12.
Camilo Correa-Gallego MD Yuman Fong MD Mithat Gonen PhD Michael I. D’Angelica MD Peter J. Allen MD Ronald P. DeMatteo MD William R. Jarnagin MD T. Peter Kingham MD 《Annals of surgical oncology》2014,21(13):4278-4283
Background
Microwave (MWA) and radiofrequency ablation (RFA) are the most commonly used techniques for ablating colorectal-liver metastases (CRLM). The technical and oncologic differences between these modalities are unclear.Methods
We conducted a matched-cohort analysis of patients undergoing open MWA or RFA for CRLM at a tertiary-care center between 2008 and 2011; the primary endpoint was ablation-site recurrence. Tumors were matched by size, clinical-risk score, and arterial-intrahepatic or systemic chemotherapy use. Outcomes were compared using conditional logistic regression and stratified log-rank test.Results
We matched 254 tumors (127 per group) from 134 patients. MWA and RFA groups were comparable by age, gender, median number of tumors treated, proximity to major vessels, and postoperative complication rates. Patients in the MWA group had lower ablation-site recurrence rates (6% vs. 20%; P < 0.01). Median follow-up, however, was significantly shorter in the MWA group (18 months [95% confidence interval 17–20] vs. 31 months [95% confidence interval 28–35]; P < 0.001). Kaplan–Meier estimates of ablation-site recurrence at 2 years were significantly lower for the lesions treated with MWA (7% vs. 18%, P: 0.01).Conclusions
Ablation-site recurrences of CRLM were lower with MWA compared with RFA in this matched cohort analysis. Longer follow-up time in the MWA may increase the recurrence rate; however, actuarial local failure estimations demonstrated better local control with MWA. 相似文献13.
Purpose
The rate of unintentionally discovered renal masses has been increasing along with a parallel increased incidence of renal cell carcinoma both in men and women. Ablation therapy has emerged as an alternative for the treatment of these small renal tumors. Several techniques have been developed for renal tumor ablation with cryoablation (CA) and radiofrequency ablation (RFA) being among the most widely used and studied. The purpose of this article is to review the role of imaging and renal mass biopsy in renal tumor ablation with focus on CA and RFA. 相似文献14.
M.?Sadat-Khonsari M.?Papayannis P.?Schriefer L.?Kluth C.?Meyer V.?Schüttfort M.?Regier M.?Rink F.?Chun M.?Fisch A.?Becker
Introduction and objective
Renal tumor biopsy is recommended for histological diagnosis of radiologically indeterminate renal masses, to select patients with small-renal masses for surveillance approaches, before ablative treatments and to confirm metastatic spread of renal cell cancer (RCC), according to the EAU guidelines. We aimed to determine outcomes of patients with suspicious renal masses with initial finding of regular renal tissue in renal tumor biopsies.Methods
Retrospective database analysis of 101 patients undergoing CT-guided-, percutaneous renal tumor biopsies in local anesthesia.Results
In 23/101 patients, histopathologic evaluation of the biopsies showed regular renal tissue. Of these, two patients underwent simultaneous radiofrequency ablation (RFA), 2/23 underwent radical nephrectomy, despite negative biopsy because of radiological suspicious aspect. Overall, 12 patients underwent a second set of biopsies due to persistent clinical suspicion. Of these, five were diagnosed with RCC: three clear cell renal cell carcinoma (ccRCC) and two papillary renal cell carcinoma (pRCC). Benign tumours were found in two patients. A lymphoma was found in two patients. In 3/12 patients, also the second set of biopsies showed regular renal tissue.Conclusion
An unsuspicious histology in CT-guided renal tumor biopsy does not preclude patients with suspicious renal masses from being diagnosed with malignancies.15.
Orhan Agcaoglu Shamil Aliyev Koray Karabulut Galal El-Gazzaz Federico Aucejo Robert Pelley Allan E. Siperstein Eren Berber 《World journal of surgery》2013,37(6):1333-1339
Background
Liver resection and radiofrequency ablation (RFA) are two surgical options in the treatment of patients with colorectal liver metastases (CLM). The aim of this study was to analyze patient characteristics and outcomes after resection and RFA for CLM from a single center.Methods
Between 2000 and 2010, 395 patients with CLM undergoing RFA (n = 295), liver resection (n = 94) or both (n = 6) were identified from a prospective IRB-approved database. Demographic, clinical and survival data were analyzed using univariate and multivariate analyses.Results
RFA patients had more comorbidities, number of liver tumors and a higher incidence of extrahepatic disease compared to the Resection patients. The 5-year overall actual survival was 17 % in the RFA, 58 % in the Resection group (p = 0.001). On multivariate analysis, multiple liver tumors, dominant lesion >3 cm, and CEA >10 ng/ml were independent predictors of overall survival. Patients were followed for a median of 20 ± 1 months. Liver and extrahepatic recurrences were seen in 69 %, and 29 % of the patients in the RFA, and 40 %, and 19 % of the patients in the Resection group, respectively.Conclusions
In this large surgical series, we described the characteristics and oncologic outcomes of patients undergoing resection or RFA for CLM. By having both options available, we were able to surgically treat a large number of patients presenting with different degrees of liver tumor burden and co-morbidities, and also manage liver recurrences in follow-up. 相似文献16.
Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? The natural history of renal angiomyolipomas (AML) shows increasing size and increasing risk of haemorrhage. For those patients undergoing treatment, extirpative surgery or renal angio‐embolization has increased morbidity. Due to its haemostatic effect, radio‐frequency ablation (RFA) may be used safely and effectively for the treatment of small (<4 cm), symptomatic renal AML. This study represents the largest case series reporting on RFA for renal AML.
OBJECTIVES
? To show that radiofrequency ablation (RFA) is safe and effective treatment for renal angiomyolipoma (AML). ? Current treatments to reduce the risk of haemorrhage include tumour extirpation, angio‐embolization, or ablative therapy.PATIENTS AND METHODS
? Review of our prospective database revealed 15 patients with intraoperative biopsy confirmed renal AML undergoing RFA from February 2002 to March 2010. ? Patients underwent either laparoscopic or computed tomography (CT)‐guided percutaneous RFA using either the Cool‐tip? (Covidien, Inc. Boulder, CO, USA) or RITA? (Angiodynamics®, Latham, NY, USA) RFA probe. ? CT at 1 month, 6 months, 1 year, and annually thereafter.RESULTS
? In all, two male and 13 female patients with seven left‐sided and eight right‐sided tumours with a mean (range) size of 2.6 (1.0–3.7) cm underwent laparoscopic (five) or CT‐guided (10) RFA. ? No intraoperative complications occurred. Minor complications included transient haematuria and intercostals nerve transection. Surgical complications included pneumonia and myocardial infarction. ? There was no radiographic evidence of persistent AML (CT enhancement) at a mean follow‐up of 21 months.CONCLUSIONS
? The haemostatic effect of RFA allows renal lesions suspicious for AML to be treated without bleeding complications. ? Avoids surgical risk of extirpation or embolization. ? RFA for renal AML is safe and effective. 相似文献17.
OBJECTIVES: In the current era, minimally invasive surgery using ablative techniques for the treatment of small renal tumours has become a more common and feasible treatment option. In this review, we present recent data regarding the utility of needle ablative techniques in the experimental and clinical settings. METHODS: We performed a comprehensive evaluation of available published data from 1997 to 2006 that were identified with PubMed. Official proceedings of internationally known scientific societies held in the same time period were also assessed. RESULTS: Two main thermoablative techniques, cryoablation (CA) and radiofrequency ablation (RFA), represent the current available minimally invasive treatments for renal cell carcinoma (RCC). CA has been more extensively studied and has gained acceptance from patients and physicians. The procedure is well tolerated by patients even with serious concomitant diseases. RFA is delivered with a monopolar alternating current. Morbidity rates for this modality remain slightly higher than those for cryotherapy. Both techniques are associated with highly successful cancer control rates at short-to-medium follow-up in patients with tumour size <3 cm. Multiple lesions can be treated simultaneously and the procedures can be repeated. However, long-term follow-up data are still lacking. CONCLUSION: Minimally invasive ablative approaches seem to represent an attractive alternative to extirpative surgery for the treatment of small renal neoplasms in select patients. Potential developments include concepts to improve the accuracy of thermal ablation using novel imaging modalities with reduction in side-effects and optimised selection and follow-up of patients to provide at least equivalent cancer control to conventional surgery. 相似文献
18.
Guilherme Cesar Soares Ruppert Leonardo Oliveira Reis Paulo Henrique Junqueira Amorim Thiago Franco de Moraes Jorge Vicente Lopes da Silva 《World journal of urology》2012,30(5):687-691
Purpose
In the operating room (OR) a touchless interface is an ideal solution since it does not demand any physical contact and still can provide the necessary control features in a cleansed and sterilized environment.Methods
Using open-source software libraries and image processing techniques, we implemented a hand tracking and gesture recognition system based on the Kinect device that enables surgeon to successfully touchlessly navigate through the image in the intraoperative setting through a personal computer. We used the InVesalius software, which provides high-quality 3D reconstruction of medical images.Results
Computed tomography data were intraoperatively fruitfully accessed through a simple and cheap solution in 4 tumor enucleations in 3 male patients in whom elective nephron-sparing surgeries were performed for small non-exophitic tumors. Mean tumor length was 2.7?cm (2.1, 2.7, 2.9 and 3.1?cm), and real-time ultrasound was not necessary for intraoperative identification in 3 of 4 endorenal tumors. All pathological reports revealed renal cell carcinoma, Fuhrman grade I, and negative inked surgical margins. No intra- or postoperative complication was reported.Conclusions
For the first time in the literature, a touchless user interface solution applying the Kinect device showed to be very efficient and enabled a low-cost and accurate control of the software InVesalius intraoperative, just using hand gestures. It can be used with any mouse-controlled software, opening an avenue for potential applications in many other areas, such as data visualization, augmented reality, accessibility, and robotics. The further validation and advancement of this technology are underway. 相似文献19.
Study Type – Therapy (systematic review) Level of Evidence 2b What's known on the subject? and What does the study add? The oncological success of partial nephrectomy in the treatment of small renal masses is well established. However, partial nephrectomy has largely supplanted the radical approach. In the last decade, laparoscopy has been adopted as the new surgical approach for the treatment of renal cell carcinoma. Laparoscopy offers the advantage of lower analgesic use, shorter hospital stay, and quicker recovery time. More recently, ablative technologies have been investigated as an alternative to laparoscopic partial nephrectomy. These techniques can often be performed percutaneously in the radiology suite, or laparoscopically without the need for hilar clamping. However, only the cryoablation and radiofrequency ablation modalities have had widespread use with several series reporting short to intermediate results. This review shows that both cryoablation and radiofrequency ablation are promising therapies in patients with small renal tumours (<4 cm), who are considered poor candidates for more involved surgery.
OBJECTIVE
- ? To determine the current status of the literature regarding the clinical efficacy and complication rates of cryoablation vs radiofrequency ablation in the treatment of small renal tumours.
METHODS
- ? A review of the literature was conducted. There was no language restriction. Studies were obtained from the following sources: MEDLINE, EMBASE and LILACS.
- ? Inclusion criteria were (i) case series design with more than one case reported, (ii) use of cryoablation or radiofrequency ablation, (iii) patients with renal cell carcinoma and, (iv) outcome reported as clinical efficacy.
- ? When available, we also quantified the complication rates from each included study.
- ? Proportional meta‐analysis was performed on both outcomes with a random‐effects model. The 95% confidential intervals were also calculated.
RESULTS
- ? Thirty‐one case series (20 cryoablation, 11 radiofrequency ablation) met all inclusion criteria.
- ? The pooled proportion of clinical efficacy was 89% in cryoablation therapy from a total of 457 cases. There was a statistically significant heterogeneity between these studies showing the inconsistency of clinical and methodological aspects.
- ? The pooled proportion of clinical efficacy was 90% in radiofrequency ablation therapy from a total of 426 cases. There was no statistically significant heterogeneity between these studies.
- ? There was no statistically significant difference regarding complications rate between cryoablation and radiofrequency ablation.
CONCLUSIONS
- ? This review shows that both ablation therapies have similar efficacy and complication rates.
- ? There is urgency for performing clinical trials with long‐term data to establish which intervention is most suitable for the treatment of small renal masses.
20.
Yasuteru Yoshinaga Yasuko Enomoto Ritsuko Fujimitsu Mikiko Shimakura Kazuki Nabeshima Akinori Iwasaki 《World journal of surgery》2013,37(2):356-363