985 LAPAROSCOPIC RENAL CRYOABLATION WITH 8-YEAR MEDIAN FOLLOW-UP: SINGLE SURGEON EXPERIENCE

Abstract

You have accessJournal of UrologyKidney Cancer: Localized II1 Apr 2010985 LAPAROSCOPIC RENAL CRYOABLATION WITH 8-YEAR MEDIAN FOLLOW-UP: SINGLE SURGEON EXPERIENCE Monish Aron, Kazumi Kamoi, Eric Remer, Andre Berger, Ricardo Brandina, Mihir Desai, and Inderbir S. Gill Monish AronMonish Aron Los Angeles, CA More articles by this author , Kazumi KamoiKazumi Kamoi Cleveland, OH More articles by this author , Eric RemerEric Remer Cleveland, OH More articles by this author , Andre BergerAndre Berger Los Angeles, CA More articles by this author , Ricardo BrandinaRicardo Brandina Los Angeles, CA More articles by this author , Mihir DesaiMihir Desai Los Angeles, CA More articles by this author , and Inderbir S. GillInderbir S. Gill Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1954AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We present 5-11 year (median 8-years) oncologic outcomes after laparoscopic renal cryoablation (LRC). METHODS Between 09/1997 and 10/2008, we performed renal cryoablation in 340 patients. Of these, 80 patients treated by a single surgeon (ISG) prior to 10/2003 (all laparoscopic) have minimum 5-year follow-up. Follow-up involved MRI imaging on postoperative day 1, 3 months, 6 months, 12 months, and then annually. Cryolesion biopsy was performed at 6-months. All data were prospectively accrued. RESULTS In the 80 patients with minimum 5-year follow-up, mean age was 66 years. Mean tumor size was 2.3 cm (0.9-5.0 cm). Median ASA score was 3, while mean BMI was 28. Five patients developed local recurrence, 2 had locoregional recurrence with metastases, and 4 had distant metastases without locoregional recurrence. Overall, there were 6 cancer deaths. In the 55 patients with biopsy-proven renal cell cancer (median follow-up 93 mos; range 60-132 mos), 5-year overall, disease-specific, and disease-free survival was 84%, 92%, and 81%, respectively, while 10-year overall, disease-specific, and disease-free survival was 51%, 83%, and 78%, respectively. On multivariate analysis, previous radical nephrectomy for RCC was the only significant predictor for both disease-free survival and disease-specific survival (p = 0.023 and 0.030, respectively). CONCLUSIONS Laparoscopic renal cryoablation is effective oncologic treatment for renal mass in select patients. Disease-specific survival of 92% at 5-years and 83% at 10-years is possible. Preceding radical nephrectomy for RCC treatment was the only independent predicting factor for both disease-free and disease-specific survival. Table 1. Patient characteristics No. patients 80 Mean age (range) 66.5(28-88) No. male (%) 51(64) ASA score 1 1(2) 2 11(18) 3 38(62) 4 11(18) Mean body mass index (range) 28.1(16.6-61.2) Mean mg/dl serum creatinine (range) 1.3(0.6-3.4) Mean ml/min/1.73m2 MDRDeGFR (range) 66.0(14.2-122) Solitary Kidney 19(24) No. renal insufficiency⁎ (%) Yes 37(46) No 43(54) No. tumors (%) 1 Renal lesion 74(93) 2 Renal lesions 4(5) 3 Renal lesions 2(2.5) Previous history of RCC (%) Total 23(29) Partial nephrectomy# 12(15) Radical nephrectomy 13(16) Pre-op mean cm tumor size on CT (range) 2.3(0.9-5.0) ⁎ Renal insufficiency indicates MDRDeGFR <60 (mL/min/1.73m2) # Eight contralateral, 2 ipsilateral, and 2 bilateral partial nephrectomies Table 2. Periopretrative demographics No. laparoscopic approach (%) Retroperitoneal 57(71) Transperitoneal 23(29) Precryoablation needle biopsy results (%) Renal cell carcinoma 55(69) Oncocytoma 8(13) Miscellaneous conditions 17(18) Fibrous tissue 6 Normal kidney tissue 5 Adipose tissue 3 Adenoma 1 Angiomyolipoma 1 Dystrophic calcification 1 No. cryoprobes used (%) 1 Cryoprobe 64(80) 2 Cryoprobes 13(16) 3 Cryoprobes 3(4) Mean cc estimated blood loss (range) 111(10-800) Mean mins cryoablation time (range) 19(7-50) Mean mins operative time (range) 191(75-420) Mean hours hospital stay (range) 48(23-384) No. postop complications (%) 8(10) Splenic hematoma1 1(gradeI) Atelectasis2 1(gradeI) Pneumonia3,4 2(gradeII) Pneumothorax5 1(gradeII) Heart failure6 1(gradeII) Retroperitoneal bleeding7 1(gradeII) Intercostal artery injury8 1(gradeIII) 1 POD 10, managed conservatively (Grade I), 2 Bilat atelectasis, O2 requirements (Grade I), 3 POD 8, readmit with pneumonia (Grade II), 4 POD 15, readmit local hosp with pneumonia (Grade II), 5 Rt pneumothorax, Chest tube req (Grade II), 6 Improved by diuretics (Grade II), 7 POD1, retroperitoneal bleeding 6u transfusion (Grade II), 8 Return OR same day, 1 L blood evacuated, 2 chest tubes (Grade III). © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e382-e383 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Monish Aron Los Angeles, CA More articles by this author Kazumi Kamoi Cleveland, OH More articles by this author Eric Remer Cleveland, OH More articles by this author Andre Berger Los Angeles, CA More articles by this author Ricardo Brandina Los Angeles, CA More articles by this author Mihir Desai Los Angeles, CA More articles by this author Inderbir S. Gill Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...