Original article
Ultrasound-guided percutaneous radiofrequency ablation for treating small renal masses
Radiofrecuencia percutánea guiada por ecografía en el tratamiento de masas renales pequeñas
Read
8
Timeswas read the article
2
Total PDF
6
Total HTML
Share statistics
array:24 [ "pii" => "S2173578617301130" "issn" => "21735786" "doi" => "10.1016/j.acuroe.2017.07.003" "estado" => "S300" "fechaPublicacion" => "2017-10-01" "aid" => "984" "copyright" => "AEU" "copyrightAnyo" => "2017" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Actas Urol Esp. 2017;41:497-503" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 7 "formatos" => array:2 [ "HTML" => 5 "PDF" => 2 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0210480617300608" "issn" => "02104806" "doi" => "10.1016/j.acuro.2017.03.001" "estado" => "S300" "fechaPublicacion" => "2017-10-01" "aid" => "984" "copyright" => "AEU" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Actas Urol Esp. 2017;41:497-503" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 61 "formatos" => array:2 [ "HTML" => 52 "PDF" => 9 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Artículo original</span>" "titulo" => "Radiofrecuencia percutánea guiada por ecografía en el tratamiento de masas renales pequeñas" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "497" "paginaFinal" => "503" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Ultrasound-guided percutaneous radiofrequency ablation for treating small renal masses" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figura 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1094 "Ancho" => 2263 "Tamanyo" => 80282 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Evolución de los valores de filtrado glomerular estimado (FGE).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "E. Trilla, C. Konstantinidis, X. Serres, D. Lorente, J. Planas, J. Placer, C. Salvador, A. Celma, C. Montealegre, J. Morote" "autores" => array:10 [ 0 => array:2 [ "nombre" => "E." "apellidos" => "Trilla" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Konstantinidis" ] 2 => array:2 [ "nombre" => "X." "apellidos" => "Serres" ] 3 => array:2 [ "nombre" => "D." "apellidos" => "Lorente" ] 4 => array:2 [ "nombre" => "J." "apellidos" => "Planas" ] 5 => array:2 [ "nombre" => "J." "apellidos" => "Placer" ] 6 => array:2 [ "nombre" => "C." "apellidos" => "Salvador" ] 7 => array:2 [ "nombre" => "A." "apellidos" => "Celma" ] 8 => array:2 [ "nombre" => "C." "apellidos" => "Montealegre" ] 9 => array:2 [ "nombre" => "J." "apellidos" => "Morote" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173578617301130" "doi" => "10.1016/j.acuroe.2017.07.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578617301130?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210480617300608?idApp=UINPBA00004N" "url" => "/02104806/0000004100000008/v1_201709260015/S0210480617300608/v1_201709260015/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173578617301142" "issn" => "21735786" "doi" => "10.1016/j.acuroe.2017.07.004" "estado" => "S300" "fechaPublicacion" => "2017-10-01" "aid" => "974" "copyright" => "AEU" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Actas Urol Esp. 2017;41:504-10" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2 "HTML" => 2 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Is there room for luminal-basal urothelial cell population quantification?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "504" "paginaFinal" => "510" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Hay lugar para la cuantificación de la población de células uroteliales luminales basales?" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1870 "Ancho" => 2140 "Tamanyo" => 221592 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Separation of cells between two populations. (A) Cells population obtained by scraping method. (B–D) Cells population acquired by enzymatic method in different times, scraping, enzymatic 30, 45 and 60<span class="elsevierStyleHsp" style=""></span>min.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "G.R. Passos, J.A. Camargo, K.L. Ferrari, G.C. Franch, A.E. Nowill, L.O. Reis" "autores" => array:6 [ 0 => array:2 [ "nombre" => "G.R." "apellidos" => "Passos" ] 1 => array:2 [ "nombre" => "J.A." "apellidos" => "Camargo" ] 2 => array:2 [ "nombre" => "K.L." "apellidos" => "Ferrari" ] 3 => array:3 [ "nombre" => "G.C." "apellidos" => "Franch" "sufijo" => "Jr." ] 4 => array:2 [ "nombre" => "A.E." "apellidos" => "Nowill" ] 5 => array:2 [ "nombre" => "L.O." "apellidos" => "Reis" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210480617300219" "doi" => "10.1016/j.acuro.2016.11.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210480617300219?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578617301142?idApp=UINPBA00004N" "url" => "/21735786/0000004100000008/v1_201709290139/S2173578617301142/v1_201709290139/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173578617301129" "issn" => "21735786" "doi" => "10.1016/j.acuroe.2017.07.002" "estado" => "S300" "fechaPublicacion" => "2017-10-01" "aid" => "968" "copyright" => "AEU" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Actas Urol Esp. 2017;41:491-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2 "HTML" => 2 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Androgen deprivation in prostate cancer and the long-term risk of fracture" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "491" "paginaFinal" => "496" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Deprivación andrógenica en cáncer de próstata y riesgo de fractura a largo plazo" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2467 "Ancho" => 1415 "Tamanyo" => 267493 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Flowchart of the study population.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S. Ojeda, M. Lloret, A. Naranjo, F. Déniz, N. Chesa, C. Domínguez, P.C. Lara" "autores" => array:7 [ 0 => array:2 [ "nombre" => "S." "apellidos" => "Ojeda" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Lloret" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Naranjo" ] 3 => array:2 [ "nombre" => "F." "apellidos" => "Déniz" ] 4 => array:2 [ "nombre" => "N." "apellidos" => "Chesa" ] 5 => array:2 [ "nombre" => "C." "apellidos" => "Domínguez" ] 6 => array:2 [ "nombre" => "P.C." "apellidos" => "Lara" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210480617300128" "doi" => "10.1016/j.acuro.2017.01.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210480617300128?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578617301129?idApp=UINPBA00004N" "url" => "/21735786/0000004100000008/v1_201709290139/S2173578617301129/v1_201709290139/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Ultrasound-guided percutaneous radiofrequency ablation for treating small renal masses" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "497" "paginaFinal" => "503" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "E. Trilla, C. Konstantinidis, X. Serres, D. Lorente, J. Planas, J. Placer, C. Salvador, A. Celma, C. Montealegre, J. Morote" "autores" => array:10 [ 0 => array:4 [ "nombre" => "E." "apellidos" => "Trilla" "email" => array:1 [ 0 => "etrilla@vhebron.net" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "C." "apellidos" => "Konstantinidis" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "X." "apellidos" => "Serres" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "D." "apellidos" => "Lorente" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "J." "apellidos" => "Planas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "J." "apellidos" => "Placer" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 6 => array:3 [ "nombre" => "C." "apellidos" => "Salvador" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 7 => array:3 [ "nombre" => "A." "apellidos" => "Celma" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 8 => array:3 [ "nombre" => "C." "apellidos" => "Montealegre" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 9 => array:3 [ "nombre" => "J." "apellidos" => "Morote" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Urología, Hospital Universitari Vall d’Hebron, Universitat Autònoma, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Radiodiagnóstico, Hospital Universitari Vall d’Hebron, Universitat Autònoma, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Radiofrecuencia percutánea guiada por ecografía en el tratamiento de masas renales pequeñas" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 702 "Ancho" => 2000 "Tamanyo" => 160932 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">(A) Exophytic isoechoic mass that uptakes contrast. (B) Homogeneous contrast uptake. (C) Positioning of the needle-electrode in the tumor center. (D) Presence of steam after procedure.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">We are currently witnessing an increase in the diagnosis of small renal masses (<span class="elsevierStyleMonospace"><</span>4<span class="elsevierStyleHsp" style=""></span>cm). This is due to the increase in incidental detection in imaging studies performed for other reasons. Another cause for this increase in diagnosing may be relating to factors such as tobacco use or obesity in developed countries.<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1–4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Experience in renal partial surgery has allowed more and more urologists to perform complex procedures with excellent oncological and functional results. However, partial nephrectomy is still considered a complex surgical procedure, which is not free of complications and occasionally may require high ischemia times.<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5–7</span></a> Another element to take into account is the increase in the diagnosis of small renal masses in the 70–90 age groups, where in a high proportion they have a non-aggressive behavior, low growth rates (1–3<span class="elsevierStyleHsp" style=""></span>mm per year), low Führman grades and low metastatic potential. In this case, we can propose active surveillance as an alternative, or conduct an active therapeutic attitude in specific cases. The European Association of Urology and AUA support the use of minimally invasive techniques (grade A recommendation) in patients with small tumors or who have a severe comorbidity and are not candidates for surgery, or have affections of hereditary syndromes such as von Hippel Lindau disease and Birt-Hogg-Dubé,<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">7–9</span></a> where they may require several surgical procedures.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Therefore, ablative techniques could represent a valid option in specific patients with oncologic results comparable to surgery in the short-and medium-term.<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">10–12</span></a> Our objective was to evaluate the initial experience in a single center with a program of radiofrequency ablation of small renal masses with a percutaneous approach and guided by contrast ultrasound.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Study design and population</span><p id="par0020" class="elsevierStylePara elsevierViewall">Between January 2007 and August 2015, a total of 164 procedures were performed in 148 patients diagnosed with small renal tumor (T1a) who were not candidates for surgery. The criteria followed were: life expectancy ≤5 years and/or 75 years old and/or associated high comorbidity (ASA III-IV) and/or patients with a single kidney with tumors difficult to locate for the surgical approach. We have also included endophytic renal lesions ≤1.5<span class="elsevierStyleHsp" style=""></span>cm, of posterior leaflet and upper pole of difficult approach by laparoscopy, regardless of patient age and/or associated comorbidity.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Prior assessment and description of the technique</span><p id="par0025" class="elsevierStylePara elsevierViewall">After the preoperative evaluation (blood count with coagulation tests and calculation of the estimated glomerular filtration rate according to the Cockcroft-Gault formula) and the signing of the informed consent, the candidates were submitted to a baseline abdominal computed tomography (CT). After the administration of intravenous contrast, a contrast-enhanced renal ultrasound was also performed to accurately determine tumor size and location, and their relationships to urinary tract and adjacent organs.</p><p id="par0030" class="elsevierStylePara elsevierViewall">All cases were performed percutaneously and with ultrasound contrast exam. Ablation was performed using a 15-cm-long Cool-tip TM RF ablation system, with different ablation diameters depending on tumor size (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The position of the patient (supine/lateral/prone) depended on the location of the mass, and all procedures were performed by conscious sedoanalgesia through intravenous remifentanil infusion and local anesthesia. We conducted an ultrasound-guided renal biopsy using an 18<span class="elsevierStyleHsp" style=""></span>G needle for histopathological study.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Occasionally, a transhepatic approach was performed in cases where tumor location did not allow direct access (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). In tumors adjacent to the colon, percutaneous hydrodistension was performed beforehand with 5% dextrose saline solution in perinephric fat to increase the distance between the mass and the intestine (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>), or cold saline infusion ureteral transcatheter in case of thermal ureteral risk.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">The electrode was placed into the tumor by real-time ultrasound and the tumor was treated using a radio frequency cycle of 12<span class="elsevierStyleHsp" style=""></span>minutes duration. We considered the treatment finished when the temperature reached was equal to or higher than 55 degrees.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Patients were discharged in 24<span class="elsevierStyleHsp" style=""></span>hours, and post-treatment ultrasound monitoring was performed to detect possible immediate complications.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Follow-up protocol</span><p id="par0050" class="elsevierStylePara elsevierViewall">The follow-up was conducted at 3, 6 and 12 months during the first year and then every six months until the 5th year, alternately performing a multi-phase CT scan and ultrasound contrast. Complete ablation was defined as the absence of contrast uptake in the treated area at the end of the procedure. Incomplete ablation or persistence was described as an increase in the size of the treated lesion and/or the presence of residual uptake in the first control after procedure (3 months). Finally, relapse was characterized by the reappearance of tumor with contrast uptake in the ablation site when it previously resulted in negative during follow-up.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">A total of 164 lesions were treated in 148 patients. The demographic characteristics and the treated masses are expressed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. We excluded 6 patients due to insufficient data or loss to follow-up. The mean age was 73.6 years (36–92), with 56% of patients older than 75 years; and 34% were women and 66% were men. Fifty percent of patients were ASA II, 42% III and 8% IV. Seven patients with a single kidney were treated, one tumor in a renal graft and three damages in native kidneys with chronic renal failure on hemodialysis.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">The average size of the mass was 2.7<span class="elsevierStyleHsp" style=""></span>cm (1.2–4.9), being 49% from the right kidney and 44.5% from the left kidney and one kidney transplanted. The location of the mass was upper pole in 39%, meso-renal in 24% and lower in 37%. In 87.8% of cases a single ablation was performed, in three cases two procedures and in one case (mass<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">></span><span class="elsevierStyleHsp" style=""></span>4) three ablations. The mean hospital stay was 1.2 days (1–6). Significant complications (Clavien-Dindo grade II) were fourteen cases, of which ten patients suffered subcapsular hematoma detected by ultrasound after the procedure, solved conservatively by resting, except for one case that required transfusion and antibiotic therapy by superinfection of the hematoma. One patient developed ureterohydronephrosis, probably of thermal origin, and two patients developed abdominal pain with CT suggestive of colitis related to thermal injury. They were treated with digestive rest and antibiotic therapy.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Baseline serum creatinine and estimated glomerular filtration (GFR) levels were assessed at 3, 12, 24 and 36 months after the procedure (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). The GFR baseline was 58.11<span class="elsevierStyleHsp" style=""></span>ml/min/1.732 (15–117<span class="elsevierStyleHsp" style=""></span>ml/min/1.732) and 57.53<span class="elsevierStyleHsp" style=""></span>ml/min/1.732 at 24 months. The prevalence of chronic kidney disease grade III or IV was 44.5% before treatment and 47.2% per year. We observed an increase of stage IV to V from 10.5% to 22.2% baseline one year after the procedure. However, the results do not show statistically significant differences in baseline creatinine levels and GFR over time (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.280 for Cp and <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.822 for GFR).</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Previous biopsy was obtained in 89 masses. The average of samples obtained was 1.6 (range: 1–6) and the mean size was 1<span class="elsevierStyleHsp" style=""></span>cm (0.2 to 2.7). The diagnosis was malignancy in 57.3% of cases: clear cell carcinoma in 31.4%, papillary carcinoma in 17.9%, chromophobe in 6.7% of cases and tubular-mucinous carcinoma in 1.1%. The result was benign in 25.8% of the biopsies: 20 oncocytomas and 2 angiomyolipomas. In 14.6% cases we obtained normal renal tissue without tumoral representation, probably due to failure of the echogenic biopsy. Low Führman grades predominated (grade I 67.9%). Additional immunohistochemical studies were performed in 41.6% of cases to complete the diagnosis.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The result showed initial success in 162 treated masses. In two cases residual tumor was objectified and forced a second procedure. Tumor recurrence was observed in two patients. The median follow-up was 27 months (3–96). There was no node or distant progression in the treated cases, nor specific cancer mortality, although six of the treated patients died during follow-up due to unrelated causes.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">Detection of T1a kidney cancer has increased and represents a new stage in urologic common practice.<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1–6</span></a> However, the behavior of these lesions is heterogeneous and, therefore, new treatment options are increasingly available. In addition, more than 70% of the tumors are diagnosed at advanced ages, where surgical treatments may be associated with increased morbidity. Thus, the usual practice is divergent in relation to the literature.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Ablative procedures open up a new possibility of minimally invasive treatment with acceptable results. Both the therapeutic application of extreme cold (cryoablation) as well as heat (radiofrequency) are widely tested procedures and with good rates of local control procedures.<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">13,14</span></a> The potential advantages of this procedure are: its minimally invasive character, there is no need for an operating room and the patients would be discharged earlier. Initially, the energy was applied in situ following an open/laparoscopic approach, but currently most centers handle lesions percutaneously guided by CT or ultrasound contrast (Sonovue). Rodriguez Faba et al. demonstrate good results with the percutaneous approach of renal masses in 28 patients by cryotherapy.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a> The advantages of contrast-enhanced CT scanning would be the absence of irradiation, its dynamic nature when locating and monitoring in real time any procedure (from initial biopsy to needle extraction after the procedure) and the assessment of possible immediate complications. Despite being a dependent operator, the experience of the radiologist is important in order to access and treat complex location lesions (upper and/or lower pole). Although most series are guided CT scans, there are data that seem to corroborate that ultrasound contrast could have advantages in performing the procedure and assessing the results, although more prospective randomized studies are required to draw conclusions.<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">16–18</span></a> Pre-planning of the procedure (CT and ultrasound contrast) is essential in order to determine those masses that cannot be treated due to their location, or are subsidiary of special measures to minimize the risks of thermal injury (hilar, near the pathway urinary tract or digestive structures). We can minimize the risk of thermal injury if we perform certain maneuvers, such as hydrodissection with dextrose saline solution (11 cases), in order to increase the distance between the target lesion and the colon/duodenum, as well as the ureteral transcatheter cold serum infusion in case of lesions close to the urinary tract (one procedure).<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">18–20</span></a> The biopsy is important to determine the nature of the lesions and establish a later follow-up. However, we did not proceed in this way in our first cases, and this could explain the good results of the series; supposing a bias in our study.</p><p id="par0090" class="elsevierStylePara elsevierViewall">No statistically significant differences were found in baseline plasma creatinine levels at 6 and 12 months, or in the GFR. These data are in agreement with the literature results despite the existing limitations: we have not correlated the data with other parameters such as tumor size and location (i.e. RENAL algorithm or others). Levinson et al. reported a slight increase in plasma creatinine from 1.05<span class="elsevierStyleHsp" style=""></span>mg/dl to 1.19<span class="elsevierStyleHsp" style=""></span>mg/dl in 31 patients, showing that ablation does not appear to influence residual renal function even in patients with one kidney.<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a> Similar data are observed in other series such as Raman et al.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> Young et al. retrospectively compared patients undergoing percutaneous radiofrequency ablation versus laparoscopic radiofrequency in 298 patients, without finding significant differences in renal function.<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a> In any case, it should be taken into account that patients undergoing ablation are usually older and are associated with comorbidities that determine a rate higher than the population with prior basal chronic kidney disease.<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Raman et al. retrospectively compared 47 patients who underwent radiofrequency ablation. Out of those patients, 42 had one kidney and renal mass by open partial nephrectomy. The group receiving radiofrequency was older (65.9 vs 59.6; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.03), presented higher ASA score (3 vs 2, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.01) and GFR rate 46.5 vs 55.9<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.04). Tumor size was higher in the group subjected to partial surgery (3.9 vs 2.8<span class="elsevierStyleHsp" style=""></span>cm, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.001). After one year, patients undergoing parcelar surgery showed lower GFR rate (24.5% vs 10.4%, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span> =<span class="elsevierStyleHsp" style=""></span>0.01) than those subjected to radio frequency, although patients undergoing open surgery suffered ischemia with an average of 27<span class="elsevierStyleHsp" style=""></span>min (13–47<span class="elsevierStyleHsp" style=""></span>min). Therefore, ablation would allow a better preservation of renal function in the short-and medium-term given the absence of ischemia.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Ablation is a well-tolerated procedure that allows early discharge. In our case, patients enter the same day and stay overnight. We are aware of the possibility of performing the treatments on an outpatient basis, which would improve the economic costs related to admission. However, many patients are elderly and have associated comorbidity.</p><p id="par0105" class="elsevierStylePara elsevierViewall">The overall success rate stood at 97.5%. In 148 (90%) patients, the lesion was treated correctly in a single session. In tumors smaller than 3<span class="elsevierStyleHsp" style=""></span>cm the success rate was 100%. When the tumor size was between 3<span class="elsevierStyleHsp" style=""></span>cm and 5<span class="elsevierStyleHsp" style=""></span>cm (51 cases) the complete ablation was achieved in one session in 37 cases, in two sessions in 10 cases, and in four cases complete ablation was not achieved, with salvage surgery indicated in two cases. In the remaining cases radiological follow-up was chosen when the disease continued stable. It seems that cancer control is acceptable despite the fact that there are no series with long-term follow-up, and in our series the positive biopsy rate is low. The few comparative studies between ablation and surgery show variable results. For example, in 2009, Turna et al. published a retrospective review of 36 partial nephrectomies versus 36 cryoablations; and 29 radiofrequencies on small renal masses with a mean follow-up of 24 months and a disease-free survival of 100%, 69.9% and 33.2% (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.001).<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> In 2010, Takaki et al. retrospectively compared the oncological results of 54 patients undergoing radical nephrectomy, 10 patients undergoing partial nephrectomy, and 51 patients undergoing radiofrequency ablation and found a 5-year disease-free survival of 95%, 75%, and 98%, respectively.<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a> Differences in favor of patients undergoing radiofrequency ablation could be due to selection bias, since in the radiofrequency group only 23.5% of the lesions had histological confirmation of malignancy. In 2007, Zagoria et al. published the results of percutaneous radiofrequency ablation in 48 renal masses with histological confirmation in 41 patients with a mean follow-up of 56 months and average tumor size of 2.6<span class="elsevierStyleHsp" style=""></span>cm (0.7 to 8.2<span class="elsevierStyleHsp" style=""></span>cm). They describe 7% of tumor persistence and 4% of relapses, and up to 7% of patients with metastatic progression, with relapse-free survival of 88%. In tumors smaller than 4<span class="elsevierStyleHsp" style=""></span>cm, no recurrence was evidenced.<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a> Tracy et al. published their results on an important series of 243 renal masses treated by radiofrequency with a laparoscopic and percutaneous approach. The average lesion size was 2.4<span class="elsevierStyleHsp" style=""></span>cm and the mean follow-up was 27 months. Only 179 were histologically confirmed tumors with recurrence-free survival of 90%, 95% metastasis-free and 99% cancer specific.<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">In conclusion, we currently have alternative treatments to surgery for the treatment of small renal masses thanks to the better knowledge of the nature, behavior, and natural history of the lesions. Available studies suggest the use of radiofrequency in small and affordable lesions in certain patients. However, it is necessary to increase evidence through randomized studies and compare them with cryotherapy and surveillance. Although the gold standard treatment is still surgery, percutaneous echocardiographic radiofrequency ablation seems to be a safe procedure, with preservation capacity of renal function and acceptable cancer monitoring rates.<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">28–30</span></a> In any case, it is necessary to take into account the possible limitations of the study due to its descriptive character and based on a single-center experience.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of interest</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres907585" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec887770" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres907584" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec887769" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Study design and population" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Prior assessment and description of the technique" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Follow-up protocol" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Results" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Discussion" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-11-11" "fechaAceptado" => "2017-03-21" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec887770" "palabras" => array:3 [ 0 => "Small renal tumor" 1 => "Radiofrequency ablation" 2 => "Renal cancer" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec887769" "palabras" => array:3 [ 0 => "Tumor renal pequeño" 1 => "Ablación por radiofrecuencia" 2 => "Cáncer renal" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The objective of this study was to analyze and assess the experience with radiofrequency ablation of small renal masses using a contrast-enhanced, ultrasound-guided percutaneous approach for patients who are not suitable for surgical resection and/or who refused surveillance or observation.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">From January 2007 to August 2015, 164 treatments were performed on a total of 148 patients. We present the patients’ clinical-radiological characteristics, oncological and functional results in the short and medium term.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The overall technical success rate was 97.5%, with a successful outcome in 1 session in 100% of the lesions ≤3<span class="elsevierStyleHsp" style=""></span>cm and 92% in lesions measuring 3–5<span class="elsevierStyleHsp" style=""></span>cm. The mean tumor diameter in the patients for whom the treatment was ultimately successful was 2.7<span class="elsevierStyleHsp" style=""></span>cm, while the mean diameter of these in the unsuccessful operations was 3.9<span class="elsevierStyleHsp" style=""></span>cm (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.05). There were no statistically significant differences in the serum creatinine levels and estimated glomerular filtration rates.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Despite the low rate of positive renal biopsies in the series, ultrasound-guided percutaneous radiofrequency ablation for treating small renal lesions appears to be an effective and safe procedure with a minimum impact on renal function, an acceptable oncologic control in the short and medium term and a low rate of complications.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El objetivo del presente estudio ha sido analizar y evaluar la experiencia en ablación por radiofrecuencia de masas renales pequeñas mediante abordaje percutáneo guiado por ecografía con contraste en pacientes no aptos para la resección quirúrgica, y/o que no aceptaron vigilancia u observación.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y método</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Desde enero de 2007 hasta agosto de 2015 se han realizado 164 tratamientos en un total de 148 pacientes. Se presentan las características clínico-radiológicas de los pacientes, los resultados oncológicos y funcionales a corto y medio plazo.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La tasa de éxito técnico global fue del 97,5%, con éxito final en una sesión en el 100% de lesiones ≤<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>cm y el 92% en lesiones entre 3–5<span class="elsevierStyleHsp" style=""></span>cm. El diámetro medio de los tumores en los que el tratamiento fue finalmente exitoso fue de 2,7<span class="elsevierStyleHsp" style=""></span>cm, mientras que el diámetro medio de estos fallos fue de 3,9<span class="elsevierStyleHsp" style=""></span>cm (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,05). No se observaron diferencias estadísticamente significativas en la creatinina sérica y en el filtrado glomerular estimado.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A pesar de la baja tasa de biopsia renal positiva en la serie, la aplicación de radiofrecuencia percutánea ecoguiada en el tratamiento de lesiones renales pequeñas parece un procedimiento eficaz y seguro, con un mínimo impacto sobre la función renal, un aceptable control oncológico a corto y medio plazo, con una baja tasa de complicaciones.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Trilla E, Konstantinidis C, Serres X, Lorente D, Planas J, Placer J, et al. Radiofrecuencia percutánea guiada por ecografía en el tratamiento de masas renales pequeñas. Actas Urol Esp. 2017;41:497–503.</p>" ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 702 "Ancho" => 2000 "Tamanyo" => 160932 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">(A) Exophytic isoechoic mass that uptakes contrast. (B) Homogeneous contrast uptake. (C) Positioning of the needle-electrode in the tumor center. (D) Presence of steam after procedure.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 744 "Ancho" => 950 "Tamanyo" => 82336 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Transhepatic ultrasound access.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 498 "Ancho" => 1850 "Tamanyo" => 99362 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">(A) Exophytic mass in the anterior valve in contact with the colon. (B) Hydrodistension with dextrose saline serum. (C) Separation of safety between the mass and the digestive tract.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1094 "Ancho" => 2263 "Tamanyo" => 78300 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Evolution of estimated glomerular filtration values (EGF).</p>" ] ] 4 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">No. patients</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">148 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age, years (mean)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">73.6 (36–92) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Sex (M/F)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">98/50 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">No tumors</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">164 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Location</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pole I. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">61 (37%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Middle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">39 (24%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Upper \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">64 (39%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Size (intermediate</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">cm)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.7 (1.2–4.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Side (right/left)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">80 (49%)/73 (44.5%), a kidney graft \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Biopsy (n</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">=</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">89)</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Benign \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">23 (25.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Clear cell c. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">28 (31.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Papillary \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16 (17.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Chromophobe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 (6.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Others \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (1.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1526526.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Demographic and pathological characteristics.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:30 [ 0 => array:3 [ "identificador" => "bib0155" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cancer Statistics, 2004" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Jemal" 1 => "R.C. Tiwari" 2 => "T. Murray" 3 => "A. Ghafoor" 4 => "A. Samuels" 5 => "E. Ward" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "CA Cancer J Clin" "fecha" => "2004" "volumen" => "54" "paginaInicial" => "8" "paginaFinal" => "29" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14974761" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0160" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Natural history of renal masses followed expectantly" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "W. Kassouf" 1 => "A.G. Aprikian" 2 => "M. Laplante" 3 => "S. Tanquay" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.ju.0000102409.69570.f5" "Revista" => array:6 [ "tituloSerie" => "J Urol" "fecha" => "2004" "volumen" => "171" "paginaInicial" => "111" "paginaFinal" => "113" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14665856" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0165" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Imaging of small renal masses: a medical success story" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R.J. Zagoria" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2214/ajr.175.4.1750945" "Revista" => array:6 [ "tituloSerie" => "AJR Am J Roentgenol" "fecha" => "2000" "volumen" => "175" "paginaInicial" => "945" "paginaFinal" => "955" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11000140" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0170" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The changing natural history of renal cell carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.J. Pantuk" 1 => "A. Zinman" 2 => "A.S. Belldegrun" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Urol" "fecha" => "2001" "volumen" => "166" "paginaInicial" => "1611" "paginaFinal" => "1623" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11586189" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0175" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of localized renal cell carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H. Van Poppel" 1 => "F. Becker" 2 => "J.A. Cadeddu" 3 => "I.S. Gill" 4 => "G. Janetschek" 5 => "M.A. Jewett" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.eururo.2011.06.040" "Revista" => array:6 [ "tituloSerie" => "Eur Urol" "fecha" => "2011" "volumen" => "60" "paginaInicial" => "662" "paginaFinal" => "672" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21726933" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0180" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The past, present, and future in management of small renal masses" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.C. Ha" 1 => "H.A. Zlomke" 2 => "N. Cost" 3 => "S. Wilson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1155/2015/364807" "Revista" => array:5 [ "tituloSerie" => "J Oncol" "fecha" => "2015" "volumen" => "2015" "paginaInicial" => "364807" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26491445" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0185" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term renal functional outcomes of minimally invasive partial nephrectomy for renal cell carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Mukkamala" 1 => "C. He" 2 => "A.Z. Weizer" 3 => "K.S. Hafez" 4 => "D.C. Miller" 5 => "J.S. Montgomery" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.urolonc.2014.04.012" "Revista" => array:6 [ "tituloSerie" => "Urol Oncol" "fecha" => "2014" "volumen" => "32" "paginaInicial" => "1247" "paginaFinal" => "1251" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24846342" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0190" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Review of radiofrequency ablation for renal cell carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Hines-Peralta" 1 => "S.N. Goldberg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1158/1078-0432.CCR-050004" "Revista" => array:7 [ "tituloSerie" => "Clin Cancer Res" "fecha" => "2004" "volumen" => "10" "numero" => "18 Pt 2" "paginaInicial" => "6328S" "paginaFinal" => "6334S" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15448026" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0195" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Radiofrequency ablation of renal cell carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Estebanez" 1 => "E. Artozki" 2 => "L. Aguirreazaldegui" 3 => "I. Crespo" 4 => "F. Bandres" 5 => "J.P. Sanz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Actas urol Esp" "fecha" => "2009" "volumen" => "33" "paginaInicial" => "251" "paginaFinal" => "258" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0200" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of renal tumours by percutaneous ultrasound-guided radiofrequency ablation using a multitined electrode: effectiveness and complications" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.L. Del Cura" 1 => "R. Zabala" 2 => "J.I. Iriarte" 3 => "M. Unda" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.eururo.2009.11.025" "Revista" => array:6 [ "tituloSerie" => "Eur Urol" "fecha" => "2010" "volumen" => "57" "paginaInicial" => "459" "paginaFinal" => "465" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19926208" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0205" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "7-Year oncological outcomes after laparoscopic and open partial nephrectomy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B.R. Lane" 1 => "I.S. Gill" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.juro.2009.10.023" "Revista" => array:6 [ "tituloSerie" => "J Urol" "fecha" => "2010" "volumen" => "183" "paginaInicial" => "473" "paginaFinal" => "479" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20006866" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0210" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term outcomes in healthy adults after radiofrequency ablation of T1a renal tumours" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Y. Ma" 1 => "S. Bedir" 2 => "J.A. Cadeddu" 3 => "J.C. Gahan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/bju.12366" "Revista" => array:6 [ "tituloSerie" => "BJU Int" "fecha" => "2014" "volumen" => "113" "paginaInicial" => "51" "paginaFinal" => "55" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24053553" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0215" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Renal ablative therapy: radiofrequency ablation and cryoablation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.D. Raman" 1 => "D.W. Hall" 2 => "J.A. Cadeddu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/jso.21194" "Revista" => array:6 [ "tituloSerie" => "J Surg Oncol" "fecha" => "2009" "volumen" => "100" "paginaInicial" => "639" "paginaFinal" => "644" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20017159" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0220" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cryoablation or radiofrequency ablation of the small renal mass: a meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.A. Kunkle" 1 => "R.G. Uzzo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/cncr.23896" "Revista" => array:6 [ "tituloSerie" => "Cancer" "fecha" => "2008" "volumen" => "113" "paginaInicial" => "2671" "paginaFinal" => "2680" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18816624" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0225" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estudio prospectivo de crioterapia renal percutánea ecoguiada: selección de casos como factor de optimización de una técnica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "O. Rodriguez Faba" 1 => "J. Palou" 2 => "A. Rosales" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.acuro.2014.03.011" "Revista" => array:6 [ "tituloSerie" => "Actas Urol Esp" "fecha" => "2015" "volumen" => "39" "paginaInicial" => "8" "paginaFinal" => "12" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25124045" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0230" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Monitoring laparoscopic radiofrequency renal lesions in real time using contrast-enhanced ultrasonography: an open-label, randomized, comparative pilot trial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Y. Chen" 1 => "J. Huang" 2 => "L. Xia" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1089/end.2012.0694" "Revista" => array:6 [ "tituloSerie" => "J Endourol" "fecha" => "2013" "volumen" => "27" "paginaInicial" => "697" "paginaFinal" => "704" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23442174" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0235" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Contrast-enhanced ultrasonography for surveillance of radiofrecuency-ablated renal tumors: a prospective, radiologist-blinded pilot study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C.B. Allard" 1 => "A. Coret" 2 => "S. Dason" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.urology.2015.04.062" "Revista" => array:6 [ "tituloSerie" => "Urology" "fecha" => "2015" "volumen" => "86" "paginaInicial" => "1174" "paginaFinal" => "1178" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26123518" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0240" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Improved outcome with combined US/CT guidance as compared to US guidance in percutaneous radiofrequency ablation of small renal masses" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Andersson" 1 => "F. Hashimi" 2 => "D. Lyrdal" 3 => "S. Lundstam" 4 => "M. Helltröm" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0284185114558974" "Revista" => array:6 [ "tituloSerie" => "Acta Radiol" "fecha" => "2015" "volumen" => "56" "paginaInicial" => "1519" "paginaFinal" => "1526" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25414370" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0245" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Radiofrequency ablation of a central renal tumor: protection of the collecting system with a retrograde cold dextrose pyeloperfusion technique" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "T.M. Wah" 1 => "P. Koenig" 2 => "H. Irving" 3 => "D.A. Gervais" 4 => "P.R. Mueller" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.RVI.0000175322.05225.0a" "Revista" => array:6 [ "tituloSerie" => "J Vasc Interv Radiol" "fecha" => "2005" "volumen" => "16" "paginaInicial" => "1551" "paginaFinal" => "1555" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16319166" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0250" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Paranephric water instillation: a technique to prevent bowel injury during percutaneous renal radiofrequency ablation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.A. Farrell" 1 => "J.W. Charboneau" 2 => "M.R. Callstrom" 3 => "C.C. Reading" 4 => "D.E. Engen" 5 => "M.L. Blute" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2214/ajr.181.5.1811315" "Revista" => array:6 [ "tituloSerie" => "AJR Am J Roentgenol" "fecha" => "2003" "volumen" => "181" "paginaInicial" => "1315" "paginaFinal" => "1317" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14573426" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0255" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term oncological and overall outcomes of percutaneous radio frequency ablation in high risk surgical patients with a solitary small renal mass" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.W. Levinson" 1 => "L.M. Su" 2 => "D. Agarwal" 3 => "M. Stroka" 4 => "T.W. Jarrett" 5 => "L.R. Kavoussi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.juro.2008.04.031" "Revista" => array:6 [ "tituloSerie" => "J Urol" "fecha" => "2008" "volumen" => "180" "paginaInicial" => "499" "paginaFinal" => "504" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18550123" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0260" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Renal functional outcomes for tumours in a solitary kidney managed by ablative or extirpative techniques" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.D. Raman" 1 => "G.V. Raj" 2 => "S.M. Lucas" 3 => "S.K. Williams" 4 => "E.M. Lauer" 5 => "K. Ahrar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1464-410X.2009.08776.x" "Revista" => array:6 [ "tituloSerie" => "BJU Int" "fecha" => "2010" "volumen" => "105" "paginaInicial" => "496" "paginaFinal" => "500" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19681900" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0265" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of safety, renal function outcomes and efficacy of laparoscopic and percutaneous radiofrequency ablation of renal masses" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E. Young" 1 => "S. Castle" 2 => "V. Gorbatiy" 3 => "R.J. Leveillee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.juro.2011.11.099" "Revista" => array:6 [ "tituloSerie" => "J Urol" "fecha" => "2012" "volumen" => "187" "paginaInicial" => "1177" "paginaFinal" => "1182" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22357170" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0270" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact on renal function of percutaneous thermal ablation of renal masses in patients with preexisting chronic kidney disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Wehrenberg-Klee" 1 => "T.W. Clark" 2 => "S.B. Malkowicz" 3 => "M.C. Soulen" 4 => "A.J. Wein" 5 => "J.I. Mondschein" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jvir.2011.09.002" "Revista" => array:6 [ "tituloSerie" => "J Vasc Interv Radiol" "fecha" => "2012" "volumen" => "23" "paginaInicial" => "41" "paginaFinal" => "45" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22019179" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0275" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Minimally invasive nephron sparing management for renal tumors in solitary kidneys" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Turna" 1 => "J.H. Kouk" 2 => "R. Frota" 3 => "R.J. Stein" 4 => "K. Kamoi" 5 => "I.S. Gill" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.juro.2009.07.066" "Revista" => array:6 [ "tituloSerie" => "J Urol" "fecha" => "2009" "volumen" => "182" "paginaInicial" => "2150" "paginaFinal" => "2157" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19758655" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0280" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Midterm results of radiofrequency ablation versus nephrectomy for t1a renal cell carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H. Tataki" 1 => "K. Yamakado" 2 => "N. Soga" 3 => "K. Arima" 4 => "A. Nakatsuka" 5 => "M. Kashima" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11604-010-0451-z" "Revista" => array:6 [ "tituloSerie" => "Jpn J Radiol" "fecha" => "2010" "volumen" => "28" "paginaInicial" => "460" "paginaFinal" => "468" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20661697" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0285" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Oncologic efficacy of CT-guided percutaneous radiofrequency ablation of renal cell carcinomas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R.J. Zagoria" 1 => "M.A. Traver" 2 => "D.M. Werle" 3 => "M. Perini" 4 => "S. Hayasaka" 5 => "P.E. Clark" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2214/AJR.07.2258" "Revista" => array:6 [ "tituloSerie" => "AJR Am J Roentgenol" "fecha" => "2007" "volumen" => "189" "paginaInicial" => "429" "paginaFinal" => "436" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17646471" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0290" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Durable oncologic outcomes after radiofrequency ablation: experience from treating 243 small masses over 7.5 years" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C. Tracy" 1 => "J. Raman" 2 => "C. Donnally" 3 => "C.K. Trimmer" 4 => "J.A. Cadeddu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/cncr.25002" "Revista" => array:6 [ "tituloSerie" => "Cancer" "fecha" => "2010" "volumen" => "116" "paginaInicial" => "3135" "paginaFinal" => "3142" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20564644" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0295" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Radiofrequency ablation of renal cell carcinoma: Part 1, Indications, results, and role in patient management over a 6-year period and ablation of 100 tumors" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D.A. Gervais" 1 => "R.S. Arellano" 2 => "F.J. McGovern" 3 => "W.S. McDougal" 4 => "P.R. Mueller" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2214/ajr.185.1.01850064" "Revista" => array:6 [ "tituloSerie" => "AJR Am J Roentgenol" "fecha" => "2005" "volumen" => "185" "paginaInicial" => "64" "paginaFinal" => "71" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15972400" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0300" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Radiofrequency ablation (RFA) of renal cell carcinoma (RCC): experience in 200 tumours" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "T.M. Wah" 1 => "H.C. Irving" 2 => "W. Gregory" 3 => "J. Cartledge" 4 => "A.D. Joyce" 5 => "P.J. Selby" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/bju.12349" "Revista" => array:6 [ "tituloSerie" => "BJU Int" "fecha" => "2014" "volumen" => "113" "paginaInicial" => "416" "paginaFinal" => "428" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24053769" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735786/0000004100000008/v1_201709290139/S2173578617301130/v1_201709290139/en/main.assets" "Apartado" => array:4 [ "identificador" => "6274" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735786/0000004100000008/v1_201709290139/S2173578617301130/v1_201709290139/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578617301130?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 1 | 0 | 1 |
| 2020 February | 1 | 2 | 3 |
| 2018 August | 1 | 0 | 1 |
| 2018 January | 1 | 0 | 1 |
| 2017 December | 1 | 0 | 1 |
| 2017 September | 1 | 0 | 1 |
