A Matched-cohort Comparison of Laparoscopic Renal Cryoablation using Ultra-thin Cryoprobes with Open Partial Nephrectomy for the Treatment of Small Renal Cell Carcinoma
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Purpose: 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. Materials and Methods: 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. Results: 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. Conclusions: 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.
Abstract
Purpose: 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. Materials and Methods: 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. Results: 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. Conclusions: 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.
참고문헌 (25)
- Fergany AF, "Long-term results ofnephron sparing surgery for localized renal cellcarcinoma:10-year followup", J Urol, 163, pp.442~5 (2000)
- Allaf ME, "Laparoscopic partial nephrectomy: evaluationof long-term oncological outcome", J Urol, 172, pp.871~3 (2004)
- Gill IS, "Laparoscopic partial nephrectomy for renaltumor: duplicating open surgical techniques", J Urol, 167, pp.469~77 (2002)
- Aron M, "Renal tumor ablation", Curr Opin Urol, 15, pp.298~305 (2005)
- Mabjeesh NJ, "Emerging nephronsparing treatments for kidney tumors: a continuum of modalitiesfrom energy ablation to laparoscopic partial nephrectomy", J Urol, 171, pp.553~60 (2004)
- Venkatesh R., "Laparoscopic partial nephrectomy forrenal masses: effect of tumor location", Urology, 68, pp.732~6 (2006)
- Baust JG, "The molecular basis of cryosurgery", BJUInt, 95, pp.1187~91 (2005)
- Goldberg SN, "Image-guided tumor ablation:standardization of terminology and reporting criteria", J VascInterv Radiol, 16, pp.765~9 (2005)
- Lee MS, "CT findings after nephron-sparing surgery of renal tumors", Am J Roentgenol, 189, pp.264~71 (2007)
- Luciani LG, "Incidental renal cellcarcinoma-age and stage characterization and clinical implications:study of 1092 patients", Urology, 56, pp.58~62 (2000)
- Gill IS, "Comparative analysis of laparoscopic vs open partialnephrectomy for renal tumors in 200 patients", J Urol, 170, pp.64~8 (2003)
- Lehman DS, "Kidney cancer ablative therapy:indications and patient selection", Curr Urol Rep, 9, pp.34~43 (2008)
- Cestari A., "Laparoscopic cryoablation of solid renalmasses: intermediate term followup", J Urol, 172, pp.1267~70 (2004)
- Gill IS, "Renal cryoablation: outcome at 3years", J Urol, 173, pp.1903~7 (2005)
- Lawatsch EJ, "Intermediate results of laparoscopic cryoablation in59 patients at the Medical College of Wisconsin", J Urol, 175, pp.1225~9 (2006)
- Wyler SF, "Intermediate-term results of retroperitoneoscopy-assisted cryotherapy for small renal tumours using multipleultrathin cryoprobes", Eur Urol, 51, pp.971~9 (2007)
- Hruby G., "Comparisonof laparoscopic partial nephrectomy and laparoscopiccryoablation for renal hilar tumors", Urology, 67, pp.50~4 (2006)
- Weld KJ, "Laparoscopic cryoablation for small renalmasses: three-year follow-up", Urology, 69, pp.448~51 (2007)
- Wright AD, "Endophytic lesions: a predictor of failure in laparoscopic renalcryoablation", J Endourol, 21, pp.1493~6 (2007)
- Bandi G., "Current practice patternsin the use of ablation technology for the management of smallrenal masses at academic centers in the United States", Urology, 71, pp.113~7 (2008)
- McKiernan J., "Partial nephrectomy for renalcortical tumors: pathologic findings and impact on outcome", Urology, 60, pp.1003~9 (2002)
- Brashears JH 3rd, "Renal cryoablation and radio frequencyablation: an evaluation of worst case scenarios in a porcinemodel", J Urol, 173, pp.2160~5 (2005)
- Warlick CA, "Clinical sequelae of radiographiciceball involvement of collecting system during computedtomography-guided percutanous renal tumor cryoablation", Urology, 67, pp.918~22 (2006)
- Hegarty NJ, "Probe-ablative nephron-sparing surgery: cryoablationversus radiofrequency ablation", Urology, 68, pp.7~13 (2006)
- Desai MM, "Laparoscopic partial nephrectomyversus laparoscopic cryoablation for the small renal tumor", Urology, pp.23~8 (2005)