Department of Urology, Columbia University Medical Center, New York, New York, USA.
J Endourol. 2010 Jul;24(7):1097-100. doi: 10.1089/end.2010.0067.
We reviewed our experience with laparoscopic cryoablation (LCA) and percutaneous cryoablation (PCA) in the management of small renal tumors and compared clinical outcomes, short-term oncologic results, and patient complications.
A retrospective comparison of two prospectively collected oncologic databases was performed. Ninety patients underwent PCA for 99 lesions and 81 patients underwent an LCA for 97 lesions. Patient characteristics, perioperative data, and tumor characteristics were recorded including age, estimated blood loss, complication rate, tumor size, and tumor pathology.
Patients in both the PCA and LCA groups had similar demographic and tumor characteristics. The PCA group had two major complications (2%), and the LCA group had three major complications (3.7%) (P = 0.374). In the LCA group, estimated blood loss was associated with tumor location with hilar tumor demonstrating a significantly higher mean blood loss (191 mL) compared with endophytic, mesophytic, and exophytic tumors (70 mL, 71 mL, 73.5 mL), respectively (P = 0.05). Malignancies rated in the PCA and LCA groups were 50.5% and 60.0%, respectively (P < 0.05). In the PCA group, nine (9.1%) patients demonstrated treatment failure with a persistent enhancement in the ablation bed. All nine were treated with a subsequent PCA. One patient had subsequent tumor bed enhancement and underwent an open radical nephrectomy. Treatment failed in three (3.1%) patients in the LCA cohort (incomplete ablation or recurrence).
With short-term follow-up, both LCA and PCA are safe and effective treatments for small renal masses. Patients undergoing PCA had a reduced hospital stay and a lower surgical complication rate, albeit with an elevated re-treatment rate. Long-term data is needed to establish long-term oncologic efficacy. Renal function did not significantly change in patients after cryoablation, including patients with a solitary kidney.
我们回顾了腹腔镜冷冻消融（LCA）和经皮冷冻消融（PCA）在小肾癌治疗中的经验，并比较了临床结果、短期肿瘤学结果和患者并发症。
对两个前瞻性收集的肿瘤学数据库进行回顾性比较。90 例患者行 PCA 治疗 99 个病灶，81 例患者行 LCA 治疗 97 个病灶。记录患者特征、围手术期数据和肿瘤特征，包括年龄、估计失血量、并发症发生率、肿瘤大小和肿瘤病理。
PCA 和 LCA 两组患者的人口统计学和肿瘤特征相似。PCA 组有 2 例严重并发症（2%），LCA 组有 3 例严重并发症（3.7%）（P=0.374）。在 LCA 组，肿瘤位置与估计失血量相关，肝门肿瘤的平均失血量（191ml）明显高于内生型、中胚层和外生型肿瘤（分别为 70ml、71ml 和 73.5ml）（P=0.05）。PCA 和 LCA 组的恶性肿瘤分别为 50.5%和 60.0%（P＜0.05）。在 PCA 组，9 例（9.1%）患者消融床持续增强，治疗失败。所有 9 例均行后续 PCA 治疗。1 例患者随后出现肿瘤床增强，行开放性根治性肾切除术。LCA 组有 3 例（3.1%）患者治疗失败（消融不完全或复发）。
短期随访显示，LCA 和 PCA 均是治疗小肾癌的安全有效方法。PCA 组患者住院时间短，手术并发症发生率低，但再治疗率升高。需要长期数据来确定长期肿瘤学疗效。冷冻消融后患者的肾功能没有明显变化，包括孤立肾患者。
