Minimally Invasive Partial Nephrectomy Versus Laparoscopic Cryoablation for Patients Newly Diagnosed with a Single Small Renal Mass

Nicola Fossati, Alessandro Larcher, Giulio M. Gadda, Daniel D. Sjoberg, Francesco A. Mistretta, Paolo Dell'Oglio, Giuliana Lista, Cristina Carenzi, Giovanni Lughezzani, Massimo Lazzeri, Francesco Montorsi, Andrew J. Vickers, Giorgio Guazzoni, Nicolò Maria Buffi

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Minimally invasive partial nephrectomy (MIPN) and laparoscopic renal cryoablation (LRC) are two treatment options increasingly used for small renal masses. Objective: To compare perioperative, oncologic, and functional outcomes after MIPN and LRC. Design, setting, and participants: We included 372 consecutive patients newly diagnosed with a single small renal mass and treated with either MIPN or LRC at a single institution. Intervention: MIPN and LRC. Outcome measurements and statistical analysis: Regression models were used to evaluate the impact of surgical treatment (MIPN vs LRC) on perioperative, oncologic, and functional outcomes. Results and limitations: Overall, 206 patients (55%) underwent MIPN and 166 (45%) were treated with LRC. In multivariate analysis, the rate of postoperative complications was significantly lower in the MIPN compared to the LRC group (20% vs 28%; adjusted difference -11%; p= 0.02) after adjusting for age at surgery, American Society of Anesthesiologists score (1 vs 2 vs 3), and tumor size. The median follow-up was similar in the two groups (43 and 39 mo for MIPN and LRC, respectively). In univariate Cox regression analysis, treatment type was not significantly associated with disease-free survival (hazard ratio 1.06, 95% confidence interval [CI] 0.45-2.52; p= 0.9). The disease-free survival rate at 5 yr was 92% in MIPN and 93% in LRC patients. In multivariate linear regression analysis, LRC was significantly associated with a higher estimated glomerular filtration rate (eGFR) at 6 mo compared to MIPN (coefficient 4.68, 95% CI 0.06-9.30; p= 0.047) after adjusting for age at surgery, tumor size, and preoperative eGFR. There was no significant association between surgical treatment and postoperative eGFR at 3 yr after surgery (coefficient -2.36, 95% CI -7.55 to 2.83; p= 0.4). Limitations include the retrospective study design and selection bias. Conclusions: MIPN and LRC provided similar cancer control and comparable renal function at intermediate-term follow-up. Both surgical techniques emerged as viable treatment options for patient newly diagnosed with a single small renal mass. Further multi-institutional studies with longer follow-up and nephrometry scores are needed to corroborate our findings. Patient summary: In patients newly diagnosed with a single small renal mass, minimally invasive partial nephrectomy and laparoscopic renal cryoablation provided similar cancer control and comparable renal function at intermediate-term follow-up.

Original languageEnglish
Pages (from-to)66-72
Number of pages7
JournalEuropean Urology Focus
Volume1
Issue number1
DOIs
Publication statusPublished - Aug 1 2015

Keywords

  • Cryosurgery
  • Minimally invasive surgery
  • Partial nephrectomy
  • Small renal mass

ASJC Scopus subject areas

  • Urology

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