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קבוצה 2 גישה לגידולי כליה קטנים

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  • 2 T1a

  • Active Surveillance (AS)

    -Radical Nephrectomy (RN) :

  • : :ORN, LRN, OPN, ORN, Laparoscopic Hand-Assisted LPN, Robot-Assisted PN

    ( ) (/) (Trans-peritoneal / Retroperitoneal)

  • : T categories for kidney cancer TX: The primary tumor cannot be assessed T0: No evidence of a primary tumorT1: The tumor is only in the kidney and measures 7 cmT1a: The tumor measures 4 cm or smaller and confined to the kidney. T1b: The tumor is larger than 4 cm but not larger than 7 cm confined to the kidney. T2: The tumor is > 7 cm across confined to the kidney. T2a: The tumor is more than 7 cm but not more than 10 cm across and confined to the kidney. T2b: The tumor is more than 10 cm across and confined to the kidney. Staging of Renal MassesT1a: The tumor measures 4 cm or smaller and confined to the kidney

  • : absolute solitary (/functioning) kidney relative morbidity in the opposite kidney elective localized unilateral RCC w/a normal contralateral kidney.

    Relative indications include hereditary forms of RCCwhich carry a high risk of tumor in the contralateral kidney.

    For elective indications, nephron-sparing surgery for tumors limited in diameter (T1a) provides recurrence-free and long-term survival rates similar to those after radical surgeryIndications for Nephron-Sparing Surgery EAU Guidelines

  • : In patients with a solitary kidney, laparoscopic partial nephrectomy results in a prolonged warm ischaemia time and a higher complication rate. Temporary or permanent dialysis is more likely to be necessary Indications for Nephron-Sparing Surgery EAU Guidelines

  • :

    :

    (Thermal Ablation)

    - RFA , '' (AS)

    : MANAGEMENT OF CLINICAL T1 RENAL MASSES AUA GUIDELINE 2009Surgical Management Options

    / Clinical T1a

  • :

    / ! -AUA - ( VHL) :

    TA AS

    : MANAGEMENT OF CLINICAL T1 RENAL MASSES AUA GUIDELINE 2009Surgical Management Options

    T1a /

  • Trends in Renal Tumor Surgery Delivery Within the United StatesLori M. Dulabon, DO1; William T. Lowrance, MD2; Paul Russo, MD2; and William C. Huang, MD1 !!

  • ? ? ?.

  • .

    " (NSS,RN) .

  • : (CT,US,MRI) .

    : 6-12 ( , )

  • 4 NSS 80% 20-30% - . ?

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    1 " (46% )

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  • NCCN Guideline: Surgical resection remains the only effective therapy for clinically localized RCCEAU Guideline: Surgical therapy is the only curative theraputic approach for the treatment of RCCBut:Patients with small tumors and/or significant co-morbidity who are unfit for surgery should be considered for an ablative approach, e.g. cryotherapy and radiofrequency ablation.

  • EAU Guideline:Pre-treatment biopsy has to be carried out as standardOther image-guided percutaneous and minimally invasive techniques, such as microwave ablation, laser ablation and high-intensity focused ultrasound ablation, are still experimental in character. The experience obtained with radiofrequency ablation and cryoablation should be considered when using these related techniques

  • Cryoablation or Radiofrequency Ablation of the Small Renal Mass - a Meta-AnalysisCancer. 2008 Nov 15;113(10):2623-6 CryoRFATumor Progression:5.2%12.9%Re Treatment Rates1.3%8.5%Metastatic Disease1%2%

  • Morbidity:Major Urological Complications (ARF, Hemorrhage, Urinary Leak, Loss of Kidney) 4.9%Non Urological Complications (PE, DVT, Bowel Perf.) 5%

  • Follow Up:Imaging ?Biopsy ?

    Imaging:Decrease in Size (lack of decrease does not entitle failure)Non Enhancement (lack of non-enhancement does not entitle failure but warrants biopsy)

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