1200 OUTCOMES OF LAPAROSCOPIC AND PERCUTANEOUS CRYOABLATION FOR RENAL MASSES

Abstract

You have accessJournal of UrologyKidney Cancer: Localized1 Apr 20131200 OUTCOMES OF LAPAROSCOPIC AND PERCUTANEOUS CRYOABLATION FOR RENAL MASSES Eric H Kim, Youssef S Tanagho, Sam B Bhayani, Nael E Saad, and R Sherburne Figenshau Eric H KimEric H Kim St. Louis, MO More articles by this author , Youssef S TanaghoYoussef S Tanagho St. Louis, MO More articles by this author , Sam B BhayaniSam B Bhayani St. Louis, MO More articles by this author , Nael E SaadNael E Saad St. Louis, MO More articles by this author , and R Sherburne FigenshauR Sherburne Figenshau St. Louis, MO More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2554AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laparoscopic cryoablation (LCA) and percutaneous cryoablation (PCA) represent minimally invasive alternatives to extirpative surgery for the treatment of renal masses. We compare perioperative, functional, and oncologic outcomes between LCA and PCA, as well as identify predictors of treatment failure following cryoablation. METHODS A retrospective chart review was performed, evaluating 149 patients undergoing LCA and 118 patients undergoing PCA at our institution between July 2000 and June 2011. RESULTS LCA and PCA were performed on 172 and 123 tumors, respectively. The following baseline characteristics differed significantly between the LCA and PCA groups, respectively: mean BMI (29.0+6.1 vs. 32.3+9.3 kg/m2, p<0.01); mean preoperative estimated glomerular filtration rate (eGFR) (62.8+24.0 vs. 70.8+25.0 mL/min/1.73m2, p<0.01); multiple ipsilateral tumors (12% vs. 4% patients, p=0.03); mean tumor size (2.3+0.8 vs. 2.7+1.1 cm, p<0.01); depth (19% vs. 11% endophytic, p=0.05); location (46% vs. 17% anterior, p<0.01); and polarity (28% vs. 46% lower pole, p<0.01). Perioperative complication rates were 10% for both groups. Mean length of stay was significantly shorter for the PCA group (2.1+0.5 vs. 3.5+3.0 days, p<0.01). Both groups had a comparable decline in eGFR at most recent follow-up (LCA -3.7+18.3 mL/min/1.73m2 at 44.5+35.2 months vs. PCA -6.6+17.1 mL/min/1.73m2 at 24.6+20.0 months, p=0.20). Mean oncologic follow-up was 70.9+31.9 months for LCA and 38.6+19.6 months for PCA. Kaplan-Meier estimated five-year overall (OS), cancer-specific (CSS), and recurrence-free survival (RFS) were 78.5%, 99.3%, 83.2% for LCA, and 86.3%, 99.2%, 86.3% for PCA. Multivariate cox proportional hazards analysis demonstrated that cryoablation approach (LCA vs. PCA) was not predictive of overall mortality, cancer-specific mortality, or disease recurrence (HR=1.38, 1.15, 1.04; p=0.38, 0.93, and 0.93, respectively). Predictors of overall mortality included age-adjusted Charlson comorbidity index > 6 (HR=2.12; p=0.01) and preoperative eGFR < 60 mL/min/1.73m2 (HR=1.86; p=0.02). Predictors of recurrence included tumor size > 3 cm (HR=2.26; p=0.03), BMI > 30 kg/m2 (HR=1.90; p=0.05), and endophytic tumor growth (HR=3.29; p=0.01). CONCLUSIONS Mean length of stay was shorter for patients undergoing PCA as compared to LCA. Complication rates as well as decline in renal function at most recent follow-up were similar between groups. Oncologic outcomes were influenced by baseline patient and tumor characteristics rather than cryoablation approach. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e492 Peer Review Report Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eric H Kim St. Louis, MO More articles by this author Youssef S Tanagho St. Louis, MO More articles by this author Sam B Bhayani St. Louis, MO More articles by this author Nael E Saad St. Louis, MO More articles by this author R Sherburne Figenshau St. Louis, MO More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...