Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
Urology. 2012 Aug;80(2):307-14. doi: 10.1016/j.urology.2012.03.044.
To evaluate perioperative and long-term functional and oncological outcomes of laparoscopic cryoablation (LCA) performed at Washington University.
A retrospective chart review was performed evaluating 62 consecutive patients who underwent LCA at our institution between 2000 and 2005.
Mean age-adjusted Charlson Comorbidity Index (CCI) was 6.1 (SD, 2.1; 95% confidence interval [CI], 5.6-6.6). Mean tumor size was 2.52 cm (SD, 0.99; CI, 2.3-2.8). Mean operative time was 162.0 minutes (SD, 66.6; CI, 142.0-182.1). Mean estimated blood loss was 84.9 mL (SD, 102; CI, 58.6-111.2). Mean hospital stay was 2.6 days (SD, 1.90; CI, 2.1-3.1). The perioperative complication rate was 9.7% (Clavien 1-2). Among patients with biopsy proven, localized renal cell carcinoma, the 6-year Kaplan-Meier estimated disease-free survival (DFS) was 80%; cancer-specific survival (CSS) was 100%; and overall survival (OS) was 76.2%. Mean follow-up in this subset was 76.0 months (SD, 39.3; CI, 62.7-89.4; n = 35), whereas mean time to cancer recurrence was 27.6 months (SD, 11.2; CI, 15.9-39.3; n = 6). Tumor size ≥2.6 cm was the only predictor of cancer recurrence in a multivariate Cox proportional hazards model (hazard ratio [HR] = 28.9; P = .046; n = 35). Mean preoperative estimated glomerular filtration rate (eGFR) was 68.3 (SD, 22.3; CI, 62.1-74.5), compared to 64.5 mL/min/1.73 m(2) (SD, 28.9; CI, 56.5-72.6) at last follow-up (P = .12; n = 52). Excluding patients requiring secondary ablative or extirpative treatments for recurrent renal cell carcinoma, preoperative eGFR <60 mL/min/1.73 m(2) (odds ratio [OR] = 88.3; P = .036) and age-adjusted CCI ≥6 (OR = 32.4; P = .046) were the only factors predicting renal disease progression on multiple logistic regression (n = 47).
We report what is by far the longest follow-up to date of postlaparoscopic cryoablation changes in eGFR and note excellent long-term renal functional outcomes. For those willing to accept the potential need for retreatment for recurrent disease, LCA offers excellent long-term CSS.
评估华盛顿大学行腹腔镜冷冻消融术（LCA）的围手术期和长期功能及肿瘤学结果。
回顾性分析了 2000 年至 2005 年期间在我院接受 LCA 的 62 例连续患者的病历。
平均年龄调整 Charlson 合并症指数（CCI）为 6.1（SD，2.1；95%置信区间 [CI]，5.6-6.6）。平均肿瘤大小为 2.52 厘米（SD，0.99；CI，2.3-2.8）。平均手术时间为 162.0 分钟（SD，66.6；CI，142.0-182.1）。平均估计失血量为 84.9 毫升（SD，102；CI，58.6-111.2）。平均住院时间为 2.6 天（SD，1.90；CI，2.1-3.1）。围手术期并发症发生率为 9.7%（Clavien 1-2）。在活检证实为局限性肾细胞癌的患者中，6 年Kaplan-Meier 估计无疾病生存率（DFS）为 80%；癌症特异性生存率（CSS）为 100%；总生存率（OS）为 76.2%。在这部分患者中，中位随访时间为 76.0 个月（SD，39.3；CI，62.7-89.4；n=35），而癌症复发的中位时间为 27.6 个月（SD，11.2；CI，15.9-39.3；n=6）。多变量 Cox 比例风险模型显示，肿瘤大小≥2.6cm 是癌症复发的唯一预测因素（风险比 [HR] = 28.9；P =.046；n=35）。术前估计肾小球滤过率（eGFR）平均为 68.3（SD，22.3；CI，62.1-74.5），而最后一次随访时为 64.5 mL/min/1.73 m(2)（SD，28.9；CI，56.5-72.6）（P=.12；n=52）。排除因复发性肾细胞癌需要二次消融或根治性治疗的患者，术前 eGFR <60 mL/min/1.73 m(2)（优势比 [OR] = 88.3；P =.036）和年龄调整 CCI ≥6（OR = 32.4；P =.046）是多因素逻辑回归（n=47）中预测肾功能进展的唯一因素。
我们报告了迄今为止腹腔镜冷冻消融术后 eGFR 变化的最长随访结果，并指出了良好的长期肾功能结果。对于那些愿意接受因复发而需要再次治疗的患者，LCA 提供了良好的长期 CSS。
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