Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 16.738
Filtrar
5.
Arch Esp Urol ; 72(9): 921-925, 2019 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-31697252

RESUMO

OBJECTIVES: Mesorenal tumors (those located in the renal middle line or between both poles) are complex cases for partial nephrectomy (PN). Our objective is to evaluate oncological and perioperative results of PN in these patients with mesorenal tumors greater than 4 cm, mesophytic or endophytic. METHODS: A review of the medical records of patients with tumors with these characteristics operated between January 2016 and June 2016 was performed. RESULTS: 36 cases were included. The mean age was 54.2 years (24-79) with 12 cases of male gender. Mean surgical time: 139 minutes (120-280); 30 cases with complete clamping with mean ischemia of 19 minutes (10-90) and 6 compression of the parenchyma. Mean estimated bleeding: 280 ml (100-900). Mean tumor diameter: 4.3 cm (4.0 to 7.6). Preoperative and postoperative mean glomerular filtration rate 89 ml/min and 76 ml/min (p=0.32) respectively. Median length of stay: 3.8 days (2-21). There were 2 (6.5%) complications (II and IIIb). One case (3.3%) presented positive margin. One patient died due to progression at 14 months. With a median follow-up of 52.1 months (10-168) no recurrences were observed. CONCLUSIONS: We consider that mesorenal tumors, with significant penetration within the renal parenchyma and greater than 4 cm, PN presents both oncological and satisfactory results.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Laparoscopia , Nefrectomia , Adulto , Idoso , Carcinoma de Células Renais/cirurgia , Humanos , Neoplasias Renais/cirurgia , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Nefrectomia/métodos , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
6.
Arch Esp Urol ; 72(9): 926-932, 2019 Nov.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31697253

RESUMO

OBJECTIVES: We aim to present and analyze the long term results of descending transperitoneal laparoscopic nephrectomy (TLN) technique (Tunc technique). METHODS: A total of 308 patients that underwent descending TLN were included to the study between January 2011 and March 2018. Mean operation time, mean estimated blood loss, duration of hospital stay, complications, mean tumor size, and pathologic margin status were analyzed. RESULTS: A total of 308 patients underwent the descending TLN technique. Mean tumor size was 6.5±1.83 (range 3.5-12 cm). Mean intraoperative estimated blood loss was 38±6.91mL. Mean operation time was 24.97±6.8 minutes. Duration of hospital stay was1.85±0.69 days. Only one patient received postoperative blood transfusion for chronic anemia. Two of the patients had endoGIA stapler malfunction. None of the patients required conversion to open surgery intraoperative. There was no positive margin status. CONCLUSIONS: We could prove the safety and effectiveness of descending TLN technique. The main advantages of descending TLN over traditional ascending nephrectomy technique are shorter operation time and hospital stay.


Assuntos
Neoplasias Renais , Laparoscopia , Nefrectomia , Humanos , Neoplasias Renais/cirurgia , Laparoscopia/métodos , Tempo de Internação , Margens de Excisão , Nefrectomia/métodos
7.
Medicine (Baltimore) ; 98(38): e17263, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31568002

RESUMO

To discuss the feasibility, safety, and effectiveness of off-clamp robotic partial nephrectomy via retroperitoneal approach and provide data for evidence based medicine in the surgical treatment of renal tumor.The clinical data was documented and compared between robotic retroperitoneal partial nephrectomy with and without hilar occlusion (clamp group and off-clamp group) performed between January 1, 2015 and December 31, 2017.Six-months post-operative renal function was superior in the off-clamp group compared with clamp group, while long-term results remained to be elucidated. No significant difference in post-operative hospital stay was found between the 2 groups. Estimated blood loss in off-clamp group was significantly higher than clamp group, while no significant difference was found in transfusion rate.Off-clamp robotic partial nephrectomy via retroperitoneal approach is a safe and effective technique for the removal of renal tumor while the indication of surgery is strictly limited to small (<4 cm) and exophytic renal tumor.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Laparoscopia , Nefrectomia/métodos , Procedimentos Cirúrgicos Robóticos , Feminino , Humanos , Neoplasias Renais/cirurgia , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Espaço Retroperitoneal/cirurgia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/métodos , Resultado do Tratamento
8.
Can Assoc Radiol J ; 70(4): 434-440, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31585824

RESUMO

PURPOSE: To determine negative predictive value (NPV) of contrast-enhanced ultrasound (CEUS) to demonstrate local tumour progression (LTP) at thermal ablation (TA) sites. METHODS: Our institutional review board approved this retrospective study; acquisition of consent was waived. Consecutive CEUS examinations performed between 2004-2014 for TA site evaluation on patients who could not undergo enhanced computed tomography (CT) or magnetic resonance imaging (MRI), or had inconclusive CT or MRI, were retrospectively reviewed. Those reported as no abnormal enhancement in or surrounding TA site were included. CEUS examination was considered true-negative based on stability or lack of enhancement/washout on follow-up imaging for at least 1 year, and false-negative (FN), if there was an arterially enhancing focus with wash-out at or surrounding TA site on subsequent follow-up imaging. RESULTS: Study population included 56 tumours in 54 patients, 11 women, 43 men; mean age 71 years. Two patients had TA of two different hepatocellular carcinomas. Thirty-six examinations were for hepatic TA and twenty for renal TA. Lesion sizes ranged from 1 cm to 7 cm (mean 3.1 ± 1.2). Mean diameter of 7 recurrences was 13.8 mm. Overall FN rate was 12.5% (7/56). Corresponding numbers were 0% (0/20) for renal TA and 19.4% (7/36) for hepatic TA. Overall NPV of CEUS was 87.5% (49/56) (confidence interval [CI]: 78.8%-96.2%). NPV for renal TA was 100% (20/20) (CI: 100%-100%) and for hepatic TA 81.5% (29/36) (CI: 67.6 %-93.5%). CONCLUSION: In this cohort, CEUS showed high NPV for exclusion of LTP at renal TA sites. NPV for hepatic TA sites was high but lower than renal TA.


Assuntos
Neoplasias Renais/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Ultrassonografia/métodos , Idoso , Idoso de 80 Anos ou mais , Ablação por Cateter , Meios de Contraste , Progressão da Doença , Feminino , Seguimentos , Humanos , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos
9.
Medicine (Baltimore) ; 98(40): e17435, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577762

RESUMO

To compare the efficacies of 3-dimensional laparoscopic partial nephrectomy and conventional laparoscopic partial nephrectomy for complex renal tumors. The complex renal tumors was defined as Preoperative Aspects and Dimensions Used for an anatomical (PADAU) ≥10, including some cT1b tumors.This was a retrospective analysis of patients with local complex renal tumors who presented to our hospital from January 2014 to January 2018. All patients were managed with laparoscopic partial nephrectomy (LPN) or 3-dimensional partial nephrectomy (3DLPN).There were 48 patients in the LPN group and 60 in the 3DLPN group. In the matched groups, demographic and tumor characteristics including Charlson Comorbidity Index, PADUA, based on the preoperative images, were similar. By contrast, 3DLPN achieved better results in terms of warm ischemia time (19 vs 27 minutes), operation time (105 vs 128 minutes), postoperative complications (14.9% vs 23.4%), and marginal width (0.6 cm vs 0.4 cm). We found statistically significant differences in terms of length of stay, estimated blood loss (EBL), positive surgical margin (PSM), and conversion to open or radical nephrectomy (RN). Median follow-up time was 17 and 18.5 months for the LPN and 3DLPN groups, respectively. The recovery of renal function (% change eGFR, 0 vs -8.7) was significantly different between the 3DLPN and LPN groups, whereas 12-month recurrence-free survival did not differ.Both 3-dimensional laparoscopic nephron-sparing nephrectomy and conventional laparoscopic partial nephrectomy are safe, effective, and acceptable approaches to treating complex renal tumors, while the former may facilitate tumor resection and renorrhaphy for challenging cases, offering a minimally invasive surgical option for patients who may otherwise require open surgery.


Assuntos
Imagem Tridimensional , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/cirurgia , Laparoscopia , Nefrectomia , Idoso , Feminino , Humanos , Neoplasias Renais/patologia , Tempo de Internação , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Duração da Cirurgia , Pontuação de Propensão , Estudos Retrospectivos , Resultado do Tratamento , Isquemia Quente
10.
Arch Esp Urol ; 72(8): 723-728, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31579029

RESUMO

The trend towards the organ sparing and robotic assisted surgeries is clear and is going to expand in the future. Hence, the tools surgeons need to facilitate such minimallly invasive approaches are going to be even more important. The Indocyanine green (ICG) is a water-soluble, relatively hydrophobic dye which bounds to plasma protein and can be used intraoperatively as real time contrast agent. Near infrared fluorescence (NIRF) helps in differentiating the renal planes, and the most common reagent used for the NIRF is ICG. The combination is used frequently during nephron sparing surgery in urology to ensure the ischemia of the kidney after clamping the renal artery, moreover it can help to identify the arterial blood supply to the tumor allowing selective clamping and thus minimizing the ischemia time. Several studies assessed the role of ICG in nephron-sparing surgery and provided evidence that its use allows to improve perioperative and oncological outcomes. This review provides an overview of the articles published regarding the use of ICG during partial nephrectomy, about the oncological outcomes and safety.


Assuntos
Imunofluorescência , Neoplasias Renais , Nefrectomia , Procedimentos Cirúrgicos Robóticos , Humanos , Verde de Indocianina , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/cirurgia , Laparoscopia , Nefrectomia/métodos
11.
Arch Esp Urol ; 72(8): 729-737, 2019 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-31579030

RESUMO

OBJECTIVES: The use of intraoperatory laparoscopic ultrasound for nephron sparring surgery (partial nephrectomy) in patients with technically challenging tumors has emerged during the last years. The objective of this work is to present a literature review and analysis of the published series, as well as the surgical technique of intraoperatory laparoscopic guided partial nephrectomy. METHODS: Pubmed and Scopus serch was performed in January 2019 including the following keywords: "intraoperative ultrasonography", "laparoscopic ultrasonography" and "partial nephrectomy", the published series are presented. We describe the laparoscopic technique of intraoperatory ultrasound during partial nephrectomy. RESULTS: All the published series present similar results in terms of tumour size which varies from 2.3 to 4 cm. Complications results are also very similar in the comparative series to the ones published in partial nephrectomies. They show promising oncological results during follow up with a rate superior to 90% of negative margins, comparable to those of exophytic tumor partial nephrectomies. CONCLUSIONS: The use of intraoperatory ultrasound during laparoscopic surgery to localize intraparenchymatous renal lesions can expand the indications of partial nephrectomy to more technically challenging tumors. These indications are not yet well standardized. Due to its complexity, the need of previous surgical experience is required to achieve good results and corroborate the security and feasibility of this procedure. Prospective randomized trials are needed to confirm the benefits of intraoperatory laparoscopic ultrasound for nephron sparring surgery (partial nephrectomy).


Assuntos
Neoplasias Renais , Laparoscopia , Nefrectomia , Ultrassonografia , Humanos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/cirurgia , Nefrectomia/métodos , Estudos Prospectivos
12.
Arch Esp Urol ; 72(8): 738-743, 2019 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-31579031

RESUMO

OBJECTIVE: Nephron sparing surgery is the gold standard in cT1 renal tumor. In order to perform a safe and effective surgery is essential a good radiological study. 3D printing is a new tool that allows the creation of virtual and physical trustworthy 3D reproduction of organs or anatomical structures of patients. METHOD: Non systematic review of PubMed database about the usefulness of 3D printing in renal surgery. RESULTS: 3D printing has a potential use in surgery planning, resident education and improving the communication and understanding of our patients. CONCLUSION: Today the number of publications and the use of these technique are still low. 3D printing is a useful tool in order to improve communication with patients and has a potential role in resident education. 3D printing technology could be useful in surgically complex cases since provides an exact model of the organ and the lesion before the intervention allowing a better surgery planning to the surgeon.


Assuntos
Imagem Tridimensional , Neoplasias Renais , Impressão Tridimensional , Humanos , Rim , Neoplasias Renais/cirurgia
13.
Arch Esp Urol ; 72(8): 744-749, 2019 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31579032

RESUMO

OBJECTIVE: To perform a literature review on the use of cavoscopy during surgery for renal cell carcinoma with vena cava thrombus (RCCVCT), according to the criteria of Evidence-Based Medicine. MATERIAL AND METHODS: We performed a Pubmed search for studies published with the following keywords: "renal tumor thrombus", "renal tumor cavoscopy" and "cystoscopy thrombus", without time limit and in English. With these criteria, 5 articles were identified with a total of 41 patients. All studies found are case series and expert opinions, so the degree of evidence in the use of cavoscopy in RCCVCT is low. RESULTS: RCCVCT surgery is a complex technique, which can reach over 50% 5-year survival, when a complete oncological resection is achieved. One of the keys for surgical success is complete resection of tumor thrombus, having used different techniques for its verification. One of them is cavoscopy, which consists on the introduction of a flexible cystoscope through the cavotomy incision after thrombectomy, checking the lumen of the vena cava with saline serum irrigation. In two series of clinical cases, cavoscopy detected thrombus persistence in 22% and 43% of patients respectively, allowing resection. The entire resected thrombus showed malignancy in several cases. CONCLUSION: Cavoscopy is a technique that improves detection of tumor remnants after thrombectomy in comparison to indirect review methods. Although oncological impact of caval thrombus is controversial, the use of cavoscopy allows a more complete resection of the thrombus, and it may offer a possible increase in the recurrence-free survival of these patients.


Assuntos
Carcinoma de Células Renais , Cistoscopia , Neoplasias Renais , Células Neoplásicas Circulantes , Nefrectomia , Trombose , Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/cirurgia , Cistoscópios , Humanos , Neoplasias Renais/complicações , Neoplasias Renais/cirurgia , Nefrectomia/métodos , Trombose/complicações , Trombose/cirurgia , Veia Cava Inferior
14.
J Biol Regul Homeost Agents ; 33(5 Suppl. 1): 95-103, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31630722

RESUMO

Despite laparoscopy in children is considered safe and is routinely used for several procedures, even in neonates and in pediatric oncology, its role in the treatment of pediatric renal tumors is still controversial. This study analyzes the results of laparoscopic nephrectomy for Wilms Tumor (WT) in pediatric age compared with open nephrectomy after 10 years of experience in a single centre. From 1993 in our center of reference for pediatric oncology, 30 patients with WT have been treated. We performed 21 open nephrectomy and in the last 10 years 9 laparoscopic nephrectomy. In all patients treated laparoscopically, the same technique made by the same equip was used. Compared with patients treated by open surgery, we did not find a significant difference in terms of outcome and survival. In the open surgery group, two patients had lung relapse while in the other group there was one local relapse. These three children obtained and maintained a second complete remission with chemotherapy. Open surgery complications were a tumor rupture in two cases, and an episode of pancreatitis 10 days after surgery. In the laparoscopic group, there were two conversions to open surgery not considered as complications but a surgical choice for cystic areas present in the tumor. As far as complications and oncologic outcomes are concerned, both techniques showed similar results. In experienced hands, laparoscopy proves to be an attractive alternative to open surgery for pediatric renal tumors.


Assuntos
Neoplasias Renais/cirurgia , Laparoscopia , Nefrectomia , Tumor de Wilms/cirurgia , Criança , Humanos , Recidiva Local de Neoplasia , Resultado do Tratamento
15.
Zhonghua Yi Xue Za Zhi ; 99(36): 2840-2843, 2019 Sep 24.
Artigo em Chinês | MEDLINE | ID: mdl-31550813

RESUMO

Objective: To evaluate the feasibility and clinical value of suprapubic-assisted laparoendoscopic single-site surgery (SA-LESS) in nephroureterectomy using method of transvaginal natural orifice specimen extraction (NOSE) (SA-LESS+TV-NOSE NU). Methods: Four patients (three cases of renal pelvic carcinoma and one case of ureteral carcinoma) undergoing SA-LESS+TV-NOSE NU were enrolled between April 2015 and January 2016. After general anesthesia, the patients were placed in the lithotomy position with the affected side elevated by 60°. Two trocars were inserted at the medial margin of umbilicus, and the third one was inserted into abdominal cavity at the superior margin of pubic symphysis. The operation was performed under a direct vision with a 5.4 mm 0° flexible-tip laparoscope. Firstly, the distal ureter was isolated completely and blocked by a Hem-O-lok clip. Then, the laparoscopic nephrectomy was performed according to the standard method. Finally, the bladder cuff excision was executed and the incision was sutured. The intact specimen was placed inside a homemade bag and removed through the incision at posterior vaginal fornix. Results: All the procedures were successfully performed. The median operative time was 150 (range: 120 to 210) minutes, and the median estimated blood loss was 180 (range: 80 to 350) ml. No major perioperative complications occurred. The mean visual analogue score (VAS) of 24 hours and 48 hours after operation were 3.25 (range: 2 to 5) and 2.25 (range: 2 to 3). All the patients resumed ambulation on postoperative day 1. Pelvic drainage tube was removed on postoperative day 2-4. On postoperative day 7, urethral catheter was removed. The patients were discharged on postoperative day 7-9. During the follow-up of 20-29 months, the patient recovered well with no case of incisional hernia and pelvic, abdominal infections. The vaginal fornix incision healed well, and the umbilical and suprapubic puncture scars were not obvious. All the patients completed the patient-assessed acromegaly symptom questionnaire PASQ. The average PSAQ score of 3 months after surgery was 34.5. Three of them restarted their sex lives, with an average female sexual function index score of 16.0, which was not significantly different with that of preoperation (15.6). There was no tumor recurrence, metastasis and implantation in all cases. Conclusion: SA-LESS+TV-NOSE NU is safe and feasible for upper tract urothelial carcinoma with faster postoperative recovery, less pain, shorter hospitalization time, better cosmetic results, and does not cause negative effect on the female sexual function.


Assuntos
Neoplasias Renais , Laparoscopia , Feminino , Humanos , Neoplasias Renais/cirurgia , Recidiva Local de Neoplasia , Nefrectomia , Nefroureterectomia , Umbigo
16.
Zhonghua Zhong Liu Za Zhi ; 41(9): 703-707, 2019 Sep 23.
Artigo em Chinês | MEDLINE | ID: mdl-31550862

RESUMO

Objective: To investigate the therapeutic effects of surgical management for local retroperitoneal recurrence of renal cell carcinoma after radical nephrectomy. Methods: Clinical and follow-up data of 33 cases of local recurrence after radical nephrectomy in Renji Hospital from January 2010 to April 2018 were retrospectively analyzed. Results: In these 33 patients, 25 was male and 8 was female; The median age was 54 years old. The pathological stage of radical nephrectomy included 14 cases of pT1-2N0M0 stage, 16 cases of pT3-4 N0M0 stage, and 3 cases of pN1 stage. Only 4 relapsing patients had symptoms, the others were all found to have recurrence by imaging examination during follow up period of postoperation.The median recurrence time for all patients was 30 months, and the median diameter of recurrent tumors was 4.5 cm.Twenty-nine patients underwent complete resection of local recurrent lesions, and 4 patients whose recurrent lesions could not be completely resected converted receive palliative surgery. The median intraoperative blood loss was 500 ml and the median hospital stay after surgery was 4 days. Clavien grade Ⅰ-Ⅱ complications occurred in 5 patients after surgery, and no serious complications of Clavien grade Ⅲ-Ⅴ complications occurred. Six patients received postoperative adjuvant target therapy and distant metastasis occurred in one patient.In the 27 patients without adjuvant target therapy, postoperative distant metastases occurred in 12 patients. The median survival time for all patients after local recurrence surgery was 31 months. The 1-year and 3-year survival rates were 86.8% and 36.9%, respectively. Conclusions: The rigorous imaging examination after radical nephrectomy can detect local recurrent lesions as early as possible in most relapsing patients and imaging examination can predict the integrity of surgical resection of local recurrence.Although intraoperative bleeding of resection of local recurrence is relatively high, the operation is safe and the postoperative complications are controllable. Postoperative adjuvant therapy may also provide better survival benefit for patients with local recurrence.


Assuntos
Carcinoma de Células Renais/cirurgia , Neoplasias Renais/cirurgia , Recidiva Local de Neoplasia/cirurgia , Neoplasias Retroperitoneais/cirurgia , Adulto , Idoso , Carcinoma de Células Renais/patologia , Feminino , Humanos , Neoplasias Renais/patologia , Masculino , Pessoa de Meia-Idade , Nefrectomia , Neoplasias Retroperitoneais/patologia , Estudos Retrospectivos , Resultado do Tratamento
17.
Hinyokika Kiyo ; 65(7): 287-289, 2019 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-31501393

RESUMO

An 83-year-old man with an indwelling lumbar-peritoneal (L-P) shunt (for idiopathic normal-pressure hydrocephalus) underwent retroperitoneal laparoscopic radical right nephrectomy for renal cell carcinoma (pT1aN0M0). Peritoneal perforation occurred intraoperatively, and he developed postoperative disturbance of consciousness. Computed tomography showed mild ventricular enlargement, which was attributed to L-P shunt failure secondary to increased pneumoperitoneum pressure. His level of consciousness was improved when we raised his head. Few reports have discussed complications observed during retroperitoneal laparoscopic surgery in patients with an indwelling L-P shunt. This case report discusses this topic along with a discussion of previously reported findings.


Assuntos
Estado de Consciência , Neoplasias Renais , Laparoscopia , Nefrectomia , Idoso de 80 Anos ou mais , Humanos , Neoplasias Renais/cirurgia , Masculino , Nefrectomia/efeitos adversos , Complicações Pós-Operatórias , Espaço Retroperitoneal
18.
Medicine (Baltimore) ; 98(37): e17172, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517871

RESUMO

The aim of the study was to report the experience and outcomes of Xp11.2 translocation renal cell carcinoma (tRCC) patients with tumor thrombus undergoing radical nephrectomy and thrombectomy.Between January 2017 and December 2017, 66 consecutive patients with RCC and venous thrombus involvement received surgical treatment at Peking University Third Hospital. Of which, 5 patients were confirmed of Xp11.2 tRCC, 61 patients were diagnosed of non-tRCC subtypes including 45 ccRCCs, 10 pRCCs, and 6 other subtypes. Demographic, clinical, operation, pathological and follow-up data were extracted for analysis. Prognostic factors were identified by Cox regression analysis.All the patients received radical nephrectomy and thrombectomy successfully. During a median follow-up of 18 months, 5 patients in non-tRCC group and 1 patient in tRCC group died of disease progression. Survival analysis revealed that Xp11.2 tRCC patients experienced shorter DFS than non-tRCC patients, however, there is no significant difference in OS between two groups. Xp11.2 tRCC histological subtype and presence of metastasis at diagnosis were identified as independent negative factors of DFS by multivariate analysis.Radical nephrectomy with thrombectomy provides an acceptable efficacy for tRCC patients with tumor thrombus extending into the venous system. In addition, multimodality treatment should be considered for advanced Xp11.2 RCCs as this subtype was a negative prognostic factor of DFS.


Assuntos
Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/cirurgia , Neoplasias Renais/complicações , Neoplasias Renais/cirurgia , Trombose Venosa/complicações , Trombose Venosa/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Renais/genética , Carcinoma de Células Renais/mortalidade , Feminino , Seguimentos , Humanos , Neoplasias Renais/genética , Neoplasias Renais/mortalidade , Masculino , Pessoa de Meia-Idade , Nefrectomia , Análise de Sobrevida , Trombectomia , Trombose Venosa/mortalidade , Adulto Jovem
20.
Br J Radiol ; 92(1103): 20190183, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31509441

RESUMO

OBJECTIVE: To evaluate the effectiveness of contrast-enhanced ultrasound (CEUS) in detecting incomplete ablation and local recurrence of renal tumors after percutaneous radiofrequency ablation (RFA). METHODS: 31 patients were included for RFA treatment and underwent CEUS examination after RFA, ablation zone and contrast distribution in the ablation area were observed, CEUS images were compared with enhanced CT/MRI images to determine the residual tumors and local recurrence of renal tumors. RESULTS: The average maximum diameters of the tumor and the ablation zone after the first RFA were 32.3 ± 14.7 mm and 35.9 ± 12.2 mm, respectively. A higher rate of complete tumor ablation was achieved if the ablation zone was larger than the primary tumor (p = 0.026). Within 1 month after RFA, contrast-enhanced CT/MRI examinations demonstrated incomplete ablation in 9 of 31 patients (29.0%), while CEUS revealed incomplete ablation in 8 of 31 patients (25.8%). The sensitivity, specificity, positive predictive value and negative predictive value of CEUS in evaluating complete ablation of renal tumors were 88.9%, 100%, 100%, 95.7%, respectively. During the follow-up period, local recurrence was reported in 2 (7.4%) of the 27 patients with complete tumor ablation. Tumor recurrence signs in the two patients were identified by both CEUS and contrast-enhanced CT/MRI. Therefore, both the sensitivity and specificity of CEUS for the evaluation of tumor recurrence were 100%. CONCLUSION: After percutaneous RFA of renal tumors, the effectiveness of CEUS in the follow-up assessment of residual and recurrent tumors is basically the same as that of contrast-enhanced CT/MRI. ADVANCES IN KNOWLEDGE: In this study, we evaluated the effectiveness of CEUS in the follow-up assessment of residual and recurrent tumors after RFA is basically the same as that of contrast-enhanced CT/MRI. Combining multiple follow-up methods may improve the detection rate of residual or recurrent tumors.


Assuntos
Ablação por Cateter/métodos , Neoplasias Renais/cirurgia , Adulto , Idoso , Meios de Contraste , Feminino , Humanos , Biópsia Guiada por Imagem/métodos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/patologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/patologia , Cuidados Pós-Operatórios/métodos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Carga Tumoral , Ultrassonografia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA