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

• Published in: European urology focus 2015-08, Vol.1 (1), p.66-72
• Main Authors: Fossati, Nicola, Larcher, Alessandro, Gadda, Giulio M, Sjoberg, Daniel D, Mistretta, Francesco A, Dell’Oglio, Paolo, Lista, Giuliana, Carenzi, Cristina, Lughezzani, Giovanni, Lazzeri, Massimo, Montorsi, Francesco, Vickers, Andrew J, Guazzoni, Giorgio, Buffi, Nicolò Maria
• Format: Article
• Language: English
• Subjects: Cryosurgery; Minimally invasive surgery; Partial nephrectomy; Small renal mass; Urology
• ISSN: 2405-4569; 2405-4569
• DOI: 10.1016/j.euf.2015.02.002

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 a