Department of Urology, Medical University of Vienna, Vienna, Austria.
J Endourol. 2011 Jun;25(6):991-7. doi: 10.1089/end.2010.0615. Epub 2011 May 13.
To directly compare perioperative, oncologic, and functional outcomes of laparoscopic renal cryoablation and open partial nephrectomy using a matched pair analysis.
A total of 41 patients who underwent laparoscopic cryoablation for an incidental, solid clinical T(1a)N(0)M(0) renal tumor were matched with 82 patients who received partial nephrectomy in cold ischemia, using optimal matching based on propensity scores, which were created on the basis of preoperative aspects and dimensions used for an anatomic classification of renal tumors (PADUA) score, preoperative glomerular filtration rate, age-adjusted Charlson comorbidity index, and sex. Median follow-up was 33.6 months.
No differences in the overall incidence of complications (cryoablation, 20%; partial nephrectomy, 17%; P=0.739) and grade of complications (P=0.424) were observed. After cryoablation, local recurrence developed in four patients with renal-cell carcinoma (n=35) after a median duration of 14 months (range 6-18 mos), but none after partial nephrectomy. The 3-year recurrence-free survival probabilities after laparoscopic renal cryoablation vs open partial nephrectomy were 83% vs 100%, respectively (P=0.015). The average decrease of estimated glomerular filtration rate during follow-up was 7.8±3.1 mL/min/1.73 m(2) after laparoscopic cryoablation and 9.8±2.3 mL/min/1.73 m(2) after open partial nephrectomy, which was not statistically significant (P=0.602).
Perioperative complications and renal functional outcomes of laparoscopic cryoablation and open partial nephrectomy are similar; however, laparoscopic cryoablation confers a substantially higher local recurrence risk of about 17% after 3 years. Therefore, laparoscopic renal cryoablation should be reserved for high-risk patients with decreased life expectancy. Careful patient counseling is advocated. Study limitations include the small sample size, the lack of randomization, and the short follow-up.
通过配对分析，直接比较腹腔镜肾冷冻消融术和开放式部分肾切除术的围手术期、肿瘤学和功能结果。
共 41 例接受腹腔镜冷冻消融术治疗偶然发现的、实体的临床 T(1a)N(0)M(0) 肾肿瘤的患者与 82 例接受冷缺血开放式部分肾切除术的患者进行了配对，基于术前方面和用于肾肿瘤解剖分类（PADUA）评分的尺寸、术前肾小球滤过率、年龄调整 Charlson 合并症指数和性别进行最佳匹配。中位随访时间为 33.6 个月。
未观察到总体并发症发生率（冷冻消融术为 20%，部分肾切除术为 17%，P=0.739）和并发症分级（P=0.424）存在差异。冷冻消融术后，4 例肾细胞癌（n=35）患者在中位时间 14 个月（范围 6-18 个月）后出现局部复发，但部分肾切除术患者无复发。腹腔镜肾冷冻消融术与开放式部分肾切除术的 3 年无复发生存率分别为 83%和 100%，差异有统计学意义（P=0.015）。随访期间，腹腔镜冷冻消融术后估算肾小球滤过率平均下降 7.8±3.1 毫升/分钟/1.73 平方米，开放式部分肾切除术后下降 9.8±2.3 毫升/分钟/1.73 平方米，差异无统计学意义（P=0.602）。
腹腔镜冷冻消融术和开放式部分肾切除术的围手术期并发症和肾功能结果相似；然而，腹腔镜冷冻消融术后 3 年局部复发风险约增加 17%。因此，腹腔镜肾冷冻消融术应保留给预期寿命较短的高危患者。提倡对患者进行仔细的咨询。研究局限性包括样本量小、缺乏随机化和随访时间短。
