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Die selektive interne Radiotherapie (SIRT) oder transarterielle Radioembolisation (TARE) ist eine Behandlungsalternative beim hepatozellulären Karzinom (HCC) oder hepatisch metastasierten kolorektalen Karzinom (mCRC) und ist mittlerweile in vielen Leitlinien verankert. Der Artikel fasst die aktuellen Leitlinien zur SIRT/TARE beim HCC bzw. mCRC zusammen.
In recent decades, percutaneous ablation procedures have evolved into a recognized treatment option for renal cell carcinoma (RCC). Thermal ablation techniques, including radiofrequency ablation (RFA), microwave ablation (MWA), and cryoablation (CA) are now incorporated in most treatment guidelines as a viable alternative, and in some cases, deemed equivalent to nephron-sparing surgery (NSS) or other surgical methods, especially for small renal masses (SRM) up to 4 cm. This review offers an overview of the most prevalent ablation techniques used to treat localized RCC. Additionally, it compares the oncological and clinical outcomes of these techniques with those of surgical options. Finally, it provides an assessment of the role that ablation treatment occupies in current guidelines. In conclusion, the use and incorporation of image-guided minimally invasive treatment options for RCC is on the rise. Existing data suggest that thermal ablation procedures (RFA, MWA, and CA) and partial nephrectomy yield comparable oncologic and clinical outcomes. Despite the data available, the recommendations for thermal ablations vary significantly across national and international guidelines.
Purpose: To report and compare the results of endovascular and open surgical treatment for erosion bleeding of visceral arteries following pancreatitis and pancreatic surgery.
Materials and Methods: This retrospective study included 65 consecutive patients (46 males, mean age 63 ± 14 years) presenting with visceral artery erosions between January 2011 and December 2020. Endpoints were technical success, freedom from reintervention, stent-graft-related complications, and 30-day and one-year mortality.
Results: The causes of erosion bleeding included complications of surgical treatment for the pancreas and upper gastrointestinal tract (75%), pancreatitis (19%), and spontaneous bleeding (6%). Pancreatectomy was performed in 34 (52%) patients, representing 2% of all pancreatectomy procedures (n = 1645) performed in our hospital during the study period. A total of 37 (57%) patients underwent endovascular treatment (EVT), and 28 (43%) patients had open surgery (OS) as a primary treatment. Eight of 37 (22%) patients in the EVT group underwent stent-graft treatment of the eroded vessels and 28 (78%) coil embolization. Six (9%) patients underwent reintervention with no significant differences between EVT and OS groups (11% vs. 7%, p = 0.692). Postoperative morbidity and complications in 52% of all patients were higher in the OS group than in the EVT group (41% vs. 68%, p = 0.029). The in-hospital 30-days mortality rate for all patients was 25%, and it was higher in the OS group than in the EVT group (14% vs. 39%, p = 0.017).
Conclusions: An endovascular-first strategy for treating visceral arteries erosions may be preferred to reduce the complications associated with open surgery if patients are hemodynamically stable and have no anastomotic insufficiency. Endovascular treatment may be associated with better in-hospital survival when compared to primary open surgery. Further studies are required to identify the optimal approach.
