sorveglianza attiva e tecniche ablative · sorveglianza attiva e tecniche ablative ... study type -...
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Sorveglianza attiva e
tecniche ablative
Maria Sara Squeo
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RENAL PRESERVATION
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M.Pierorazio et al, Reviews in Urology 2012
• SRMs sono biologicamente eterogenei (20-30% benigni)• 70-80% delle neoplasie maligne sono di basso grado• < 2% progressione a mts
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CONCLUSIONI: “i tassi di progressione locale sono bassi e le mtsrare. Molti NON crescono (anche se RCC alla biopsia) e tra quelli che crescono il tasso di crescita è basso…”MA… “in mancanza di studi prospettici e con FU adeguati…RISERVARE QUESTO APPROCCIO CLINICO A PAZIENTI CHE NON HANNO LUNGA ASPETTATIVA DI VITA”
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CONCLUSIONI: la crioablazione è una tecnica chirurgica semplice e meno invasiva della LPN ed è una NOTEVOLE OPZIONE DITRATTAMENTO DELLE PICCOLE MASSE RENALI.È associata a bassi tassi di complicanze e a un bassissimo impatto sulla FUNZIONE RENALE
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MA…
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“AN UPDATE TO CLINICAL GUIDELINES WOULD BE WARRANTED…”
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CONCLUSIONI:- recurrence-free survival sovrapponibile per PN, percRFA e percCryoablation- metastases-free survival superiore per PN e percCryo- OS superior in PN (selection bias?)
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ALTHOUGH THE CONCLUSION THAT AN “UPDATE TO CLINICAL GUIDELINES MAY BE WARRENTED” IS NOT SUPPORTED BY THESE DATA, THE STUDY CALL TO ACTION FOR THE UROLOGY COMMUNITY TO CONDUCT PROSPECTIVE, RANDOMIZED EVALUATION OF AVAILABLE TREATMENT MODALITIES FOR PATIENTS WITH RENAL MASS.
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