Böbrek Kanserinde Kriyoablasyon
Özet
Bu çalışma, küçük böbrek kitlelerinin (<4 cm) tedavisinde minimal invazif bir seçenek olan kriyoablasyon (KA) yöntemini, endikasyonları, teknikleri, başarı oranları ve komplikasyonları açısından değerlendirmektedir. Küçük böbrek tümörlerinde altın standart parsiyel nefrektomi (PN) olmakla birlikte, cerrahiyi tolere edemeyen yaşlı hastalar, soliter böbreği veya kronik böbrek yetmezliği olanlar için KA küratif bir alternatif sunar. Yöntem, USG, BT veya MRG kılavuzluğunda perkütan ya da laparoskopik olarak uygulanabilmektedir. Klinik T1a tümörlerde laparoskopik ve perkütan KA'nın kansere özgü sağkalım oranı %100'e ulaşmaktadır. PN ile karşılaştırıldığında KA, daha iyi perioperatif sonuçlar (daha kısa operasyon süresi, daha az kan kaybı ve hastanede kalış süresi) sağlamasına rağmen, lokal nüks oranları PN'ye göre daha yüksektir. Radyofrekans ablasyon (RFA) ile benzer onkolojik sonuçlar ve komplikasyon oranlarına sahip olan KA'da en sık görülen perioperatif sorun kanamadır. Avrupa Üroloji Derneği (EAU) ve Amerikan Üroloji Derneği (AUA) gibi güncel kılavuzlar, komorbiditesi olan kırılgan hastalarda, özellikle 4 cm'den küçük solid kitlelerde, işlem öncesi biyopsi yapılması şartıyla KA'yı alternatif bir tedavi olarak önermektedir.
This study evaluates cryoablation (CA), a minimal invasive option for treating small renal masses (<4 cm), focusing on its indications, techniques, success rates, and complications. Although partial nephrectomy (PN) remains the gold standard, CA offers a curative alternative for elderly patients unfit for major surgery, or those with solitary kidneys or chronic renal failure. CA can be performed percutaneously or laparoscopically under USG, CT, or MRI guidance. For clinical T1a tumors, both laparoscopic and percutaneous CA demonstrate cancer-specific survival rates reaching 100%. Compared to PN, CA provides superior perioperative outcomes, including reduced operative time, lower blood loss, and shorter hospital stays; however, it is associated with a higher risk of local recurrence. While CA exhibits similar oncological outcomes and complication rates to radiofrequency ablation (RFA), bleeding remains its most common perioperative complication. Current guidelines from major associations, such as the EAU and AUA, recommend thermal ablation as an alternative for frail patients with significant comorbidities, specifically for solid tumors smaller than 4 cm, emphasizing that a pre-procedural biopsy is mandatory.
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