Laparoscopic Cryoablation for Small Renal Masses: Three-Year Follow-up

• Published in: Urology (Ridgewood, N.J.) Vol. 69; no. 3; pp. 448 - 451
• Main Authors: Weld, Kyle J, Figenshau, Robert S, Venkatesh, Ramakrishna, Bhayani, Sam B, Ames, Caroline D, Clayman, Ralph V, Landman, Jaime
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-03-2007; Elsevier Science
• Subjects: Adult; Biological and medical sciences; Comorbidity; Cryosurgery - methods; Female; Follow-Up Studies; Humans; Kidney Neoplasms - epidemiology; Kidney Neoplasms - surgery; Laparoscopy; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Urology; Nephrology; Treatment; Urinary system; Cryosurgery; Surgery; Laparoscopy; Endoscopy; Kidney; Urology
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2006.10.030

Abstract Objectives To report our experience with laparoscopic renal cryoablation for patients who have completed a minimum of 3 years of follow-up. Methods From July 2000 to March 2005, 81 patients underwent laparoscopic renal cryoablation for renal masses. Of these 81 patients, 31 (38%) underwent laparoscopic renal cryoablation for 36 tumors and have completed a minimal follow-up of 3 years (mean 45.7 months). The postoperative follow-up protocol consisted of serial contrast-enhanced computed tomography or magnetic resonance imaging at 1 day, 1, 3, 6, and 12 months, and yearly thereafter. Results Twenty-seven tumors were partially exophytic, five were totally endophytic, and four were hilar tumors. The mean operative time was 2.9 hours, with a mean estimated blood loss of 97 mL. The mean renal tumor size was 2.1 cm. In early follow-up, the ablation zone was larger than the tumor but subsequently diminished to the original tumor size 6 months postoperatively. Thereafter, the ablation zone size decreased. The biopsy results revealed that 22 tumors (61%) were malignant and 14 (39%) were benign. The renal tumor 3-year cancer-specific survival rate was 100%, and no patient developed metastatic disease. One patient demonstrated return of abnormal enhancement within the cryolesion during follow-up, suggesting tumor recurrence. One patient had a hemorrhage and urinary leak after cryoablation of an endophytic tumor and was treated conservatively. Conclusions Renal cryoablation is safe and offers a minimally invasive nephron-sparing alternative. The oncologic adequacy of renal cryoablation requires long-term follow-up data, but the intermediate-term data seem equivalent to that achieved with extirpative therapy.