Homayoun Zargar1, Dinesh Samarasekera1, Ali Khalifeh1, Erick M Remer2, Charles O'Malley3, Oktay Akca1, Riccardo Autorino1, Jihad H Kaouk4. 1. Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH. 2. Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, OH. 3. Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, OH. 4. Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH. Electronic address: kaoukj@ccf.org.
Abstract
OBJECTIVE: To analyze our 15-year experience with small renal masses ablation and present oncologic and functional outcomes of laparoscopic cryoablation (LCA) and percutaneous cryoablation (PCA). MATERIALS AND METHODS: We identified patients who underwent LCA (n = 275) or PCA (n = 137) for small renal masses between 1997 and 2012. Differences in overall survival (OS) and recurrence-free survival (RFS) were analyzed using a log-rank test. Cox proportional hazard ratios model was used to determine factors that predicted OS. Fit proportional hazard risk ratios were also calculated to determine if there were any factors that affected tumor recurrence. RESULTS: Tumor sizes were equal between the 2 groups; however, tumors in the PCA group were more complex. The overall (7.27% and 7.29%) and major complications (0.7% and 3.6%) were similar. The estimated probability of 5-year OS for LCA and PCA was 89% and 82%, respectively. The estimated probability of the 5-year RFS for LCA and PCA was 79% and 80%, respectively. Heart disease (hazard ratio, 2.15; 95% confidence interval, 1.35-3.41; P = .001) and history of disease recurrence (hazard ratio, 2.49; 95% confidence interval, 1.60-3.86; P = .001; P <.0001) were predictors of death. The median follow-up time for the LCA group (4.41 years [1.67-6.91 years]) was longer than the PCA group (3.15 years [1.37-4.08 years]; P = .0001). CONCLUSION: We found no significant difference in OS or RFS at 5 years between the 2 groups. Tumor size and anterior location affected local recurrence rates, and these factors should be taken into consideration when choosing the appropriate treatment plan. RENAL nephrometry score or type of cryoablation was not associated with tumor recurrence.
OBJECTIVE: To analyze our 15-year experience with small renal masses ablation and present oncologic and functional outcomes of laparoscopic cryoablation (LCA) and percutaneous cryoablation (PCA). MATERIALS AND METHODS: We identified patients who underwent LCA (n = 275) or PCA (n = 137) for small renal masses between 1997 and 2012. Differences in overall survival (OS) and recurrence-free survival (RFS) were analyzed using a log-rank test. Cox proportional hazard ratios model was used to determine factors that predicted OS. Fit proportional hazard risk ratios were also calculated to determine if there were any factors that affected tumor recurrence. RESULTS:Tumor sizes were equal between the 2 groups; however, tumors in the PCA group were more complex. The overall (7.27% and 7.29%) and major complications (0.7% and 3.6%) were similar. The estimated probability of 5-year OS for LCA and PCA was 89% and 82%, respectively. The estimated probability of the 5-year RFS for LCA and PCA was 79% and 80%, respectively. Heart disease (hazard ratio, 2.15; 95% confidence interval, 1.35-3.41; P = .001) and history of disease recurrence (hazard ratio, 2.49; 95% confidence interval, 1.60-3.86; P = .001; P <.0001) were predictors of death. The median follow-up time for the LCA group (4.41 years [1.67-6.91 years]) was longer than the PCA group (3.15 years [1.37-4.08 years]; P = .0001). CONCLUSION: We found no significant difference in OS or RFS at 5 years between the 2 groups. Tumor size and anterior location affected local recurrence rates, and these factors should be taken into consideration when choosing the appropriate treatment plan. RENAL nephrometry score or type of cryoablation was not associated with tumor recurrence.
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