郭威廷 袁倫祥 陳盈伸 林仁泰 蔡政諭 余家政 吳東霖
高雄榮總 外科部 泌尿科
Comparison of partial nephrectomy and percutaneous radiofrequency ablation for small renal masses in the manner of preoperative aspects and dimensions used for an anatomical (Padua) classification
Wei-Ting Kuo, Lun-Hsiang Yuan, Yin-Shen Chen, Jen-Tai Lin, Jeng-Yu Tsai, Chia-Cheng Yu, Tony T. Wu
Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C.
We present our experience with the clinical feature, efficacy and outcome of comparison of partial nephrectomy and radiofrequency ablation (RFA) for small renal tumors in the manner of Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) Classification as a minimal invasive treatment in VGHKS
Materials and Methods:
A total of 78 patients in 15 years with small renal tumors were enrolled. We use Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) Classification for renal tumor classification and compared PN (42 patients) and RFA (36 patients) with clinical outcome (local recurrence-free, metastases-free, and overall survival rates), RFA procedure (RFA needle, No. of treatment, Anesthesia, complication), renal function deterioration after procedure and pathology report. We also use clustered needle or switch mode control of RFA and D5W instillation for separating bowel loop.
The median value of the PADUA score was 7.5 (IQR: 7–9), which is no significant difference between two groups. Of the 56 cT1a patients, 32 underwent PN, 24 underwent RFA. In this cohort, local recurrence-free survival, metastases-free survival were similar among the two treatments ( p = 0.53 / 0.46). Of the 22 cT1b patients, 10 patients underwent PN, and 12 patients were managed with RFA. In this cohort, local recurrence-free survival ( p = 0.76) and metastases-free survival ( p = 0.51) were similar between PN and RFA. In both the cT1a and cT1b groups, PN patients were significantly younger, with lower Charlson scores and had superior overall survival ( p < 0.001 for all). In the RFA group, all patients have been biopsy before RFA and 22 been proved RCC. The number of RFA needle treatment were significantly correlated to PADUA score. 13 patients were under local anesthesia, the other were under IVGA by anesthesiologist. Only one patient presented mild pneumothorax after RFA without intervention treatment. Renal function deterioration after procedure did not reveal clinical
significance. Tumor recurrence was recognized by CT scan in 3 patients during followup, who repeated
RFA treatment without recurrence.
For carefully selected patients, RFA represent a less invasive alternative associated with less morbidity and fewer complications and a promising treatment compared with partial nephrectomy . However, the long-term efficacy of these approaches remains to be established.