A Matched-cohort Comparison of Laparoscopic Renal Cryoablation using Ultra-thin Cryoprobes with Open Partial Nephrectomy for the Treatment of Small Renal Cell Carcinoma

Abstract

To evaluate the feasibility and efficacy of performing laparoscopic renal cryoablation (LRC) for the treatment of RCC, as compared with open partial nephrectomy (OPN), which is the established NSS. From April 2004, among the patients who underwent LRC with a 1.47 mm cryoprobe, we enrolled 20 patients who were pathologically confirmed as having RCC with a tumor size smaller than 4 cm. These patients were matched with a group of 20 patients, who were selected based on the pre-operative characteristics of the tumor and those of the patients, from a pre-existing database of the patients who underwent OPN during the same period. The mean age and tumor size were 56.3+/-11.5 years and 2.4+/-1.7 cm in the LRC group, and 57.6+/-10.9 years and 2.2+/-1.1 cm in the OPN group. The two groups were similar for their age, gender, BMI, ASA, the tumor characteristics and the indications for operation. While the pathologic results and the operation time showed similarity, the EBL (98+/-87 ml vs 351+/-147 ml, respectively, p=0.001), the transfusion rate (10% vs 40%, respectively, p=0.03) and the hospital stay (4.2+/-1.5 days vs 8.2+/-2.4 days, respectively, p=0.005) were significantly less in the LRC group. Major complications did not occur in the LRC group, but in the OPN group, one patient experienced urine leakage and one patient had a perirenal hematoma. During the mean follow up of 27.3+/-10.8 months and 28.7+/-14.9 months for each group, respectively, all the patients remained disease-free with no evidence of local recurrence or metastases. LRC using ultra-thin cryoprobes for the treatment of small RCC showed similar effective oncologic results with the merits of minimal invasiveness, as compared with OPN, during the intermediate term follow up.