838 LAPAROSCOPIC RADICAL NEPHRECTOMY VERSUS LAPAROSCOPIC RADIOFREQUENCY ABLATION: RENAL FUNCTION OUTCOMES WITH 3 YEAR FOLLOW-UP

Abstract

You have accessJournal of UrologyTechnology & Instruments: Laparoscopy: Malignant & Benign Disease1 Apr 2013838 LAPAROSCOPIC RADICAL NEPHRECTOMY VERSUS LAPAROSCOPIC RADIOFREQUENCY ABLATION: RENAL FUNCTION OUTCOMES WITH 3 YEAR FOLLOW-UP Robert Carey, Christopher Martin, Mark Murnane, and Marco Ferrara Robert CareyRobert Carey Sarasota, FL More articles by this author , Christopher MartinChristopher Martin Sarasota, FL More articles by this author , Mark MurnaneMark Murnane Gainesville, FL More articles by this author , and Marco FerraraMarco Ferrara Sarasota, FL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.405AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To present renal function outcomes in a series of patients with solid enhancing renal masses (SERM) greater than 3 cm treated with laparoscopic radiofrequency ablation (LRFA) versus laparoscopic radical nephrectomy (LRN) performed at a tertiary care center. METHODS All patients undergoing LRFA or LRN for SERM were prospectively entered into an IRB approved database. Renal function was assessed at 3 months and annually thereafter. Changes in GFR were calculated using the Modification of Diet in Renal Disease formula. LRFA was performed with a Covidien Cooltip probe system using multiple probes and multi-pass technique. Direct real-time, fiberoptic temperature monitoring was performed for each case with temperature goals of greater than 60 degrees C achieved at the deep and peripheral margins. RESULTS The LRFA group (n = 64) had mean tumor size 3.8 cm, mean nephrometry score 6.6 (4 û 9) and mean follow up of 37.8 months. For the LRN group (n = 48), mean tumor size 5.1 cm and mean follow up 34.5 months. For LRFA the decline in GFR per year is 5.8% and for LRN is 15.4% (p < 0.001). When selecting for T1b LRFA tumors (mean size 5.1 cm), the decline in GFR is 12.9%, whereas for the T1b LRN group the decline in GFR 15.0% (p = 0.60). For LRFA, low nephrometry complexity (NS 4 - 6) shows a decline in eGFR of only 2.3% versus 9.0% for tumors with moderate complexity (NS 7 - 9, p = 0.027). Our inclusion criteria mandated that the patient have at least 12 months of follow-up. Pathology showed 72(64%) were clear cell RCC, 15(13%) were papillary RCC, 21(19%) were oncocytic neoplasm, 1(<1%) chromophobe, and 3(3%) angiomyolipoma. All biopsies were performed at the time of surgery and no biopsies were non-diagnostic. Local recurrence rate for LRFA was 4.4% in two patients that had RCC and both were re-ablated successfully. Four patients in the LRN group either progressed to or had preexisting metastasis and were excluded. There were no blood transfusions or deaths for the LRFA or LRN groups. CONCLUSIONS LRFA provides a nephron-sparing alternative to LRN for renal tumors greater than 3 cm, showing durable, markedly significant preservation of renal function over 3 years of follow up with equivalent early oncological outcomes. The benefit of renal preservation with LRFA declines with increasing tumor size, showing no signficant difference in GFR for a subset of T1b SERMs with a mean tumor size is 5.1 cm. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e343-e344 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Robert Carey Sarasota, FL More articles by this author Christopher Martin Sarasota, FL More articles by this author Mark Murnane Gainesville, FL More articles by this author Marco Ferrara Sarasota, FL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...