Objectives: Thermal ablation has emerged as an effective, nephron-sparing treatment for small renal masses (SRMs), particularly in patients with comorbidities. However, tumor recurrence remains a challenge, necessitating evidence-based approaches for salvage management. This review examines the outcomes of minimally invasive modalities for managing recurrence following the primary ablation of SRMs.Methods: A literature review was conducted using the Medline database, following PRISMA guidelines. Studies published between 1981 and 2024 were screened based on predefined PICO criteria. Inclusion focused on patients with tumor recurrence after primary ablation therapy who underwent minimally invasive salvage treatments including repeat ablation, laparoscopic/robotic partial or radical nephrectomy, or active surveillance. Data extracted included patient demographics, initial treatments, recurrence timelines, salvage modalities, and outcomes.Results: Of 364 patients across 29 studies, 249 (68.4%) underwent re-ablation, 82 (22.5%) were treated with laparoscopic/robotic partial or radical nephrectomy, and 33 (9%) were managed with active surveillance. Among 249 patients with re-ablation, 179 (71.9%) showed no evidence of disease, 67 (26.9%) experienced recurrence, and outcomes were indeterminate in 3 (1.2%). Salvage minimally invasive partial or radical nephrectomy outcomes were available for 64 cases, with 63 (98.4%) showing no recurrence. In 33 patients under active surveillance, 4 died, 4 underwent surgery, and 25 remained under monitoring, though follow-up data were limited.Conclusion: Minimally invasive salvage modalities, such as re-ablation and laparoscopic/robotic partial or radical nephrectomy, effectively manage tumor recurrence, achieving >70% and >98% oncological success, respectively, despite technical challenges. Future studies directly comparing these modalities are essential for establishing standardized protocols for salvage management.
目的：热消融已成为治疗小肾肿瘤（SRMs）的一种有效且保留肾单位的方法，尤其适用于合并症患者。然而，肿瘤复发仍是一个挑战，需要基于证据的挽救性管理策略。本综述探讨了SRMs初次消融后复发采用微创方式处理的结果。 方法：遵循PRISMA指南，使用Medline数据库进行文献综述。根据预设的PICO标准筛选1981年至2024年间发表的研究。纳入标准聚焦于初次消融治疗后肿瘤复发并接受微创挽救性治疗的患者，包括重复消融、腹腔镜/机器人肾部分切除术或根治性肾切除术，或主动监测。提取的数据包括患者人口统计学特征、初始治疗、复发时间线、挽救性治疗方式及结果。 结果：在29项研究共364例患者中，249例（68.4%）接受了重复消融，82例（22.5%）接受了腹腔镜/机器人肾部分切除术或根治性肾切除术，33例（9%）采用主动监测管理。在249例重复消融患者中，179例（71.9%）无疾病证据，67例（26.9%）出现复发，3例（1.2%）结果不确定。64例挽救性微创肾部分切除术或根治性肾切除术的结果显示，63例（98.4%）无复发。在33例主动监测患者中，4例死亡，4例接受了手术，25例仍在监测中，但随访数据有限。 结论：尽管存在技术挑战，微创挽救性治疗方式（如重复消融和腹腔镜/机器人肾部分切除术或根治性肾切除术）能有效管理肿瘤复发，分别实现>70%和>98%的肿瘤学成功率。未来直接比较这些治疗方式的研究对于建立标准化的挽救性管理方案至关重要。
Minimally Invasive Salvage Approaches for Management of Recurrence After Primary Renal Mass Ablation
肿瘤(癌症)患者之家