Section of Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
BJU Int. 2012 Jan;109(1):118-24. doi: 10.1111/j.1464-410X.2011.10287.x. Epub 2011 Sep 2.
We compare perioperative, functional and intermediate-term oncological outcomes of laparoscopic partial nephrectomy (LPN) vs laparoscopic cryoablation (LCA) for small renal tumour in patients with a solitary kidney. A treatment algorithm is also proposed.
Over a 10-year period (02/1998-09/2008), 78 patients with a small tumour in a functionally solitary kidney underwent LPN (n = 48) or LCA (n = 30). Baseline, perioperative, and follow-up data were collected prospectively and analyzed retrospectively.
Demographic data were similar between the LPN and LCA groups. Tumours were somewhat larger (3.2 vs 2.6 cm) in the LPN group. LPN was associated with greater blood loss (391 vs 162 mL; P = 0.003), and trended towards more post-operative complications (22.9% vs 6.7%; P = 0.07). By 3 months post-operative, eGFR decreased by 14.5% and 7.3% after LPN and LCA, respectively (P = 0.02). Post-operative temporary dialysis was required after 3 LPN (6.2% vs 0%, P = 0.16). Median follow-up time for LPN and LCA was 42.7 and 60.2 months, respectively. Local recurrence was detected in 4 (13.3%) LCA patients only (P = 0.02). Overall survival was comparable between LPN and LCA at 3 and 5 years, respectively (P = 0.74). The LPN group had superior cancer-specific and recurrence-free survival at 3 and 5 years compared to the LCA group (P < 0.05, for all comparisons).
Given adequate technical expertise, both LPN and LCA are viable nephron-sparing options for patients with tumour in a solitary kidney. Although LCA is technically easier and has superior functional outcomes, oncologic outcomes are superior after LPN.
我们比较了腹腔镜部分肾切除术（LPN）与腹腔镜冷冻消融术（LCA）治疗孤立肾小肿瘤患者的围手术期、功能和中期肿瘤学结果。我们还提出了一种治疗方案。
在 10 年期间（1998 年 2 月至 2008 年 9 月），78 例功能孤立肾小肿瘤患者接受了 LPN（n = 48）或 LCA（n = 30）治疗。前瞻性收集了基线、围手术期和随访数据，并进行了回顾性分析。
LPN 和 LCA 两组的人口统计学数据相似。LPN 组肿瘤稍大（3.2cm 对 2.6cm）。LPN 组出血量更多（391ml 对 162ml；P = 0.003），术后并发症发生率略高（22.9%对 6.7%；P = 0.07）。术后 3 个月，LPN 和 LCA 后 eGFR 分别下降 14.5%和 7.3%（P = 0.02）。3 例 LPN 患者术后需要临时透析（6.2%对 0%，P = 0.16）。LPN 和 LCA 的中位随访时间分别为 42.7 个月和 60.2 个月。仅在 4 例（13.3%）LCA 患者中发现局部复发（P = 0.02）。LPN 和 LCA 的 3 年和 5 年总生存率相当（分别为 P = 0.74）。LPN 组在 3 年和 5 年时的癌症特异性和无复发生存率均优于 LCA 组（所有比较 P < 0.05）。
在具备足够技术专长的情况下，LPN 和 LCA 都是治疗孤立肾肿瘤患者的可行保肾选择。虽然 LCA 技术上更简单，功能结果更好，但 LPN 的肿瘤学结果更好。
