[Current treatment of small renal masses]. / Tratamiento actual de las masas renales pequeñas.

UNLABELLED: Incidental diagnosis of renal carcinoma (RC) is increasingly common due to widespread use of radiodiagnostic techniques for other conditions. In developed countries, incidental tumor account for more than 40% of detected tumors, and 80% of solid kidney tumors less than 4 cm in size are malignant. Standard treatment for these tumors is partial nephrectomy, and their relapse rate is 1%-2% The higher increase in diagnosis of this disease has occurred in patients aged 70 to 90 years, a group where associated comorbidities are very common. In the past two decades, in parallel to development of radiographic techniques, two ablation procedures achieving tumor necrosis through cold, cryotherapy, and through heat, radiofrequency, have become established. These procedures achieve 95% short- and long-term remissions in tumors less than 4 cm in size. In addition, since these procedures may be performed percutaneously, both complications and hospital stay have decreased. As early as in 1995, Bosniak, based on observation of the growth and behavior of small RCs for longer than 8 years, advocated a watchful waiting or active surveillance attitude. This article reports cryotherapy, our radiofrequency series, and a literature review. CONCLUSIONS: In the event of elderly patients, concomitant diseases advising against surgery, multiple renal tumors, a solitary kidney, or patients who reject surgery, ablation procedures may be safe and effective when performed by expert hands, achieving mid-term oncological results similar to partial nephrectomy. Active surveillance has also been shown to be safe in the mid-term in adequately informed patients. To improve indications, new diagnostic procedures that help us differentiate the potentially more aggressive tumors will be required. Larger series and longer follow-ups are neede to confirm current results.

Tratamiento actual de las masas renales pequeñas / Current treatment of small renal masses

Cada día son diagnosticados con más frecuencia de manera incidental Carcinomas Renales (CR), debido al aumento del uso de las técnicas de Radiodiagnóstico para el estudio de otras patologías. Su incidencia en los países desarrollados es superior al 40%, siendo malignos el 80% de los tumores sólidos de riñón menores de 4cm. El tratamiento estándar de este tipo de tumores es la nefrectomía parcial con un índice de recidivas del 1-2%. El mayor incremento en el diagnostico de esta patología se ha producido en pacientes entre los 70 y 90 años, grupo de edad que se acompaña de gran numero de comorbilidades. En las dos ultimas décadas y acompañando al desarrollo de las técnicas radiológicas, se han establecido entre nosotros dos técnicas, ablativas, que a través del frío, la Crioterapia (CA), y a través del calor, la Radiofrecuencia (RFA), consiguen la necrosis del tumor. Los resultados oncológicos a corto y medio plazo alcanzan un 95% de remisiones en tumores menores de 4 cm. y al ser técnicas que se pueden realizar por vía percutánea, tanto las complicaciones como las estancias hospitalarias han disminuido. Ya en 1995 Bosniak basándose en la experiencia de la observación del crecimiento y conducta de los CR pequeños durante más de 8 años propugna la postura de “Esperar y Ver” o “Vigilancia Activa” (VA). Presentamos la CA, nuestra serie de RAF y revisamos la literatura de la VA. Conclusiones: En pacientes con edad avanzada, enfermedades concomitantes que desaconsejen la cirugía, monorrenos, con tumores renales múltiples o pacientes que rechacen la cirugía, las técnicas ablativas pueden ser utilizadas de manera segura y eficaz en manos expertas, alcanzando a medio plazo resultados oncológicos similares a la nefrectomía parcial, del mismo modo que en pacientes correctamente informados la vigilancia activa se ha demostrado como segura a medio plazo. Para mejorar las indicaciones, serán necesarias nuevas técnicas diagnósticas, que nos ayuden a diferenciar los tumores potencialmente más agresivos de los que no se van a desarrollar y series mayores y con más años de evolución para confirmarlos resultados actuales (AU)

Incidental diagnosis of renal carcinoma (RC) is increasingly common due to widespread use of radiodiagnostic techniques for other conditions. In developed countries, incidental tumor account for more than 40% of detected tumors, and 80% of solid kidney tumors less than 4 cm in size are malignant. Standard treatment for these tumors is partial nephrectomy, and their relapse rate is 1%-2%. The higher increase in diagnosis of this disease has occurred in patients aged 70 to 90 years, a group where associated comorbidities are very common. In the past two decades, in parallel to development of radiographic techniques, two ablation procedures achieving tumor necrosis through cold, cryotherapy, and through heat, radiofrequency, have become established. These procedures achieve 95% short- and long-term remissions in tumors less than 4 cm in size. In addition, since these procedures may be performed percutaneously, both complications and hospital stay have decreased. As early as in 1995, Bosniak, based on observation of the growth and behavior of small RCs for longer than 8 years, advocated a watchful waiting or active surveillance attitude. This article reports cryotherapy, our radiofrequency series, and a literature review. Conclusions: In the event of elderly patients, concomitant diseases advising against surgery, multiple renal tumors, a solitary kidney, or patients who reject surgery, ablation procedures may be safe and effective when performed by expert hands, achieving mid-term oncological results similar to partial nephrectomy. Active surveillance has also been shown to be safe in the mid-term in adequately informed patients. To improve indications, new diagnostic procedures that help us differentiate the potentially more aggressive tumors will be required. Larger series and longer follow-ups are neede to confirm current results (AU)