Catherine and Joseph Aresty Department of Urology, University of Southern California Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA.
J Urol. 2010 Mar;183(3):889-95. doi: 10.1016/j.juro.2009.11.041. Epub 2010 Jan 20.
We present 5 to 11-year (median 8) oncological outcomes after laparoscopic renal cryoablation.
Between September 1997 and October 2008 we performed renal cryoablation in 340 patients, of whom 80 treated laparoscopically by a single surgeon before October 2003 had a minimum 5-year followup. Followup involved magnetic resonance imaging on postoperative day 1, at 3, 6 and 12 months, and annually thereafter. Cryolesion biopsy was performed at 6 months. All data were prospectively accrued.
In the 80 patients with minimum 5-year followup mean age was 66 years, mean tumor size was 2.3 cm (range 0.9 to 5.0), median American Society of Anesthesiologists score was 3 and mean body mass index was 28 kg/m(2). Five patients had local recurrence, 2 had locoregional recurrence with metastasis and 4 had distant metastasis without locoregional recurrence. Six patients died of cancer. In the 55 patients with biopsy proven renal cell cancer at a median followup of 93 months (range 60 to 132) 5-year overall, disease specific and disease-free survival rates were 84%, 92% and 81%, and 10-year rates were 51%, 83% and 78%, respectively. On multivariate analysis previous radical nephrectomy for RCC was the only significant predictor of disease-free and disease specific survival (p = 0.023 and 0.030, respectively).
Laparoscopic renal cryoablation is effective oncological treatment for a renal mass in select patients. A disease specific survival rate of 92% at 5 years and 83% at 10 years is possible. Preceding radical nephrectomy for renal cell carcinoma was the only independent factor predicting disease-free and disease specific survival.
我们报告了 5 至 11 年（中位数 8 年）后腹腔镜肾冷冻消融的肿瘤学结果。
1997 年 9 月至 2008 年 10 月期间，我们对 340 例患者进行了肾冷冻消融治疗，其中 80 例由一位外科医生在 2003 年 10 月之前行腹腔镜治疗，这些患者的随访时间至少为 5 年。随访包括术后第 1 天、第 3、6 和 12 个月以及此后每年进行磁共振成像检查。术后 6 个月行冷冻消融活检。所有数据均为前瞻性收集。
在 80 例随访时间至少 5 年的患者中，平均年龄为 66 岁，平均肿瘤大小为 2.3 厘米（范围 0.9 至 5.0），美国麻醉医师协会评分中位数为 3，平均体重指数为 28kg/m²。5 例患者发生局部复发，2 例患者发生局部区域复发伴转移，4 例患者发生远处转移而无局部区域复发。6 例患者死于癌症。在中位随访时间为 93 个月（范围 60 至 132 个月）的 55 例经活检证实为肾细胞癌的患者中，5 年总体生存率、疾病特异性生存率和无病生存率分别为 84%、92%和 81%，10 年生存率分别为 51%、83%和 78%。多因素分析显示，先前的肾细胞癌根治性肾切除术是无病生存和疾病特异性生存的唯一显著预测因素（p=0.023 和 0.030）。
腹腔镜肾冷冻消融术是一种有效的治疗选择，可用于特定患者的肾肿瘤。5 年和 10 年的疾病特异性生存率分别为 92%和 83%。肾细胞癌根治性肾切除术是无病生存和疾病特异性生存的唯一独立预测因素。
