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06.04.2018 | Review | Ausgabe 3/2018 Open Access

Insights into Imaging 3/2018

Image-guided minimally invasive treatment for small renal cell carcinoma

Insights into Imaging > Ausgabe 3/2018
Miltiadis E. Krokidis, Panagiotis Kitrou, Stavros Spiliopoulos, Dimitrios Karnabatidis, Konstantinos Katsanos
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Surgical partial nephrectomy is still considered as the “gold standard” for the definitive management of small malignant renal masses, whereas treatment with image-guided percutaneous ablation is still mainly reserved for those patients who cannot undergo nephron-sparing surgical resection due to advanced age, underlying comorbidities or compromised renal function. Nonetheless, the recent evidence that underlines the long-term oncological equipoise of percutaneous ablation methods with surgical resection in combination with the reduced complication rate and cost supports the use of an image-guided minimally invasive approach as a first-line treatment. The purpose of this review is to offer an overview of the most widely used percutaneous renal ablation treatments (radiofrequency, microwave and cryoablation) with a focus on their main technical aspects and application techniques for curative ablation of small renal cell carcinoma (stage cT1a). The authors also provide a critical narrative of the relevant medical literature with an emphasis on outcomes of comparative effectiveness research, and appraise the percutaneous methods compared to surgery in the context of evidence-based practice and future research studies.

Teaching Points

RCC is a common cancer and is increasingly detected incidentally at early stages.
There is long-term oncological equipoise of percutaneous ablation compared to surgical resection.
Large-scale trials are required to produce Level 1a evidence.
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