Liječenje malih tumora bubrega ablacijskim metodama

Ana Marija Alduk, Nikola Knežević, Luka Penezić, Tomislav Kuliš, Eleonora Goluža, Ivica Sjekavica, Željko Kaštelan

Mali tumor bubrega je radiološkim metodama utvrđena tvorba promjera do 4 cm. Kirurško liječenje je terapija izbora ovakvih tumora, ali se kod starijih bolesnika s komorbiditetima preporučuju i ablacijske metode. Cilj je ovoga rada prikazati naša iskustva liječenja malih tumora bubrega ablacijskim metodama. Učinili smo retrospektivnu analizu serije bolesnika liječenih radiofrekventnom i mikrovalnom ablacijom u Kliničkom bolničkom centru Zagreb u razdoblju od siječnja 2017. godine do kolovoza 2019. godine. Svim bolesnicima učinjena je odgovarajuća radiološka i preoperativna obrada, biopsija tumora i ablacija. Praćeni su prema standardnom protokolu radiološkim metodama 3, 6 i 12 mjeseci postoperativno te nakon toga jednom godišnje. Ablacija 32 mala tumora bubrega učinjena je kod 31 pacijenta, od čega 27 radiofrekventnih i 7 mikrovalnih ablacija. Jednogodišnje ukupno i tumor specifično preživljenje bilo je 100%, a kod 12,9% bolesnika utvrđen je rezidualni tumor. Troje ih je liječeno ponovnom ablacijom, a jedan radikalnom nefrektomijom. Imali smo četiri komplikacije iz 2. skupine po Clavien-Dindo klasifikaciji. Ablacijske metode su onkološki dobra i sigurna terapija kod bolesnika koji nisu pogodni za kirurški zahvat.

Small renal tumor is a radiologically detected renal mass up to four cm in diameter. Surgery is the main therapeutic option in the treatment of these tumors, but in elderly and comorbid patients ablative techniques are the alternative. The aim of this paper is to report our experience in the treatment of small renal tumors with ablative techniques. We retrospectively analyzed patient records of individuals treated with radiofrequency and microwave ablation at the University hospital center Zagreb in the period from January 2017 to August 2019. An appropriate radiological and preoperative work-up was performed for all subjects, and then tumor biopsy and
ablation. Patients were followed using the standard follow-up schedule: three, six, and 12 months after the procedure, and then annually, using radiological methods. Ablation of 32 small renal tumors was performed for 31 patients, 27 of which were radiofrequency and seven microwave ablations. One-year overall and cancer specific survival was 100%. In 12.9% of patients a residual mass was diagnosed – three were retreated with ablation and one underwent radical nephrectomy. We had four ClavienDindo grade 2 complications. Ablative techniques are an oncologically effective and safe treatment option for patients that are unfit for surgery.