Comparison of Percutaneous and Laparoscopic Renal Cryoablation for Small (<3.0 cm) Renal Masses

Abstract

Purpose:

We reviewed our experience with laparoscopic cryoablation (LCA) and percutaneous cryoablation (PCA) in the management of small renal tumors and compared clinical outcomes, short-term oncologic results, and patient complications.

Patients and Methods:

A retrospective comparison of two prospectively collected oncologic databases was performed. Ninety patients underwent PCA for 99 lesions and 81 patients underwent an LCA for 97 lesions. Patient characteristics, perioperative data, and tumor characteristics were recorded including age, estimated blood loss, complication rate, tumor size, and tumor pathology.

Results:

Patients in both the PCA and LCA groups had similar demographic and tumor characteristics. The PCA group had two major complications (2%), and the LCA group had three major complications (3.7%) (P = 0.374). In the LCA group, estimated blood loss was associated with tumor location with hilar tumor demonstrating a significantly higher mean blood loss (191 mL) compared with endophytic, mesophytic, and exophytic tumors (70 mL, 71 mL, 73.5 mL), respectively (P = 0.05). Malignancies rated in the PCA and LCA groups were 50.5% and 60.0%, respectively (P < 0.05). In the PCA group, nine (9.1%) patients demonstrated treatment failure with a persistent enhancement in the ablation bed. All nine were treated with a subsequent PCA. One patient had subsequent tumor bed enhancement and underwent an open radical nephrectomy. Treatment failed in three (3.1%) patients in the LCA cohort (incomplete ablation or recurrence).

Conclusions:

With short-term follow-up, both LCA and PCA are safe and effective treatments for small renal masses. Patients undergoing PCA had a reduced hospital stay and a lower surgical complication rate, albeit with an elevated re-treatment rate. Long-term data is needed to establish long-term oncologic efficacy. Renal function did not significantly change in patients after cryoablation, including patients with a solitary kidney.

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References

Simmons

, Weight

, Gill

. Laparoscopic radical versus partial nephrectomy for tumors >4 cm: Intermediate-term oncologic and functional outcomes. Urology, 2009; 73:1077–1082.

Kim

, Rha

, Hernandez

et al. Laparoscopic radical versus partial nephrectomy: Assessment of complications. J Urol, 2003; 170:408–411.

Novick

, Campbell

, Belldegrun

et al. Guidelines for management of the clinical stage 1 renal mass. American Urological Association Education and Research, Inc., 2009.

Finley

, Lee

, Eichel

et al. Fibrin glue-oxidized cellulose sandwich for laparoscopic wedge resection of small renal lesions. J Urol, 2005; 173:1477–1481.

Dindo

, Demartines

, Clavien

. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg, 2004; 240:205–213.

Johnson

, Solomon

, Su

et al. Defining the complications of cryoablation and radio frequency ablation of small renal tumors: A multi-institutional review. J Urol, 2004; 172:874–877.

Hoffmann

, Bischof

. The cryobiology of cryosurgical injury. Urology, 2002; 60,suppl 1:40–49.

Bischof

, Wolkers

, Tsvetkova

et al. Lipid and protein changes due to freezing in Dunning AT-1 cells. Cryobiology, 2002; 45:22–32.

Gage

, Baust

. Mechanisms of tissue injury in cryosurgery. Cryobiology, 1998; 37:171–186.

10.

Shingleton

, Sewell

Jr.

Cryoablation of renal tumours in patients with solitary kidneys. BJU Int, 2003; 92:237–239.

11.

Munver

, Disick

, Lombardo

et al. Cryoablation of small renal tumors in patients with solitary kidneys: Initial experience. Adv Urol, 2008; 197324.

12.

Turna

, Kaouk

, Frota

et al. Minimally invasive nephron sparing management for renal tumors in solitary kidneys. J Urol, 2009; 182:2150–2157.

13.

Hruby

, Reisiger

, Venkatesh

et al. Comparison of laparoscopic partial nephrectomy and laparoscopic cryoablation for renal hilar tumors. Urology, 2006; 67:50–54.

14.

Bandi

, Hedican

, Moon

et al. Comparison of postoperative pain, convalescence, and patient satisfaction after laparoscopic and percutaneous ablation of small renal masses. J Endourol, 2008; 22:963–967.