Nielsen Tommy K, Lagerveld Brunolf W, Keeley Francis, Lughezzani Giovanni, Sriprasad Seshadri, Barber Neil J, Hansen Lars U, Buffi Nicole M, Guazzoni Giorgio, van der Zee Johan A, Ismail Mohamed, Farrag Khaled, Emara Amr M, Lund Lars, Østraat Øyvind, Borre Michael
Department of Urology, Aarhus University Hospital, Aarhus, Denmark.
Department of Urology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.
BJU Int. 2017 Mar;119(3):390-395. doi: 10.1111/bju.13615. Epub 2016 Aug 26.
To assess complication rates and intermediate oncological outcomes of laparoscopic-assisted cryoablation (LCA) in patients with small renal masses (SRMs).
A retrospective review of 808 patients treated with LCA for T1a SRMs from 2005 to 2015 at eight European institutions. Complications were analysed according to the Clavien-Dindo classification. Kaplan-Meier analyses were used to estimate 5- and 10-year disease-free survival (DFS) and overall survival (OS).
The median [interquartile (IQR)] age was 67 (58-74) years. The median (IQR) tumour size was 25 (19-30) mm. The transperitoneal approach was used in 77.7% of the patients. The median postoperative hospital stay was 2 days. In all, 514 patients with a biopsy-confirmed renal cell carcinoma (RCC) were available for survival analyses. The median (IQR) follow-up for the RCC-cohort was 36 (14-56) months. A total of 32 patients (6.2%) were diagnosed with treatment failure. The 5-/10-year DFS was 90.4%/80.0% and 5-/10-year OS was 83.2%/64.4%, respectively. A total of 134 postoperative complications (16.6%) were reported, with severe complications (grade ≥III) in 26 patients (3.2%). An American Society of Anesthesiologists score of 3 was associated with an increased risk of overall complications (odds ratio 2.85, 95% confidence interval 1.32-6.20; P = 0.005).
This large series of LCA demonstrates satisfactory long-term oncological outcomes for SRMs. However, although LCA is considered a minimally invasive procedure, risk of complications should be considered when counselling patients.
评估腹腔镜辅助冷冻消融术（LCA）治疗小肾肿块（SRM）患者的并发症发生率和中期肿瘤学结局。
对2005年至2015年期间在8家欧洲机构接受LCA治疗T1a期SRM的808例患者进行回顾性研究。根据Clavien-Dindo分类法分析并发症。采用Kaplan-Meier分析评估5年和10年无病生存率（DFS）及总生存率（OS）。
中位年龄[四分位间距（IQR）]为67（58 - 74）岁。肿瘤大小的中位数（IQR）为25（19 - 30）mm。77.7%的患者采用经腹途径。术后中位住院时间为2天。共有514例经活检确诊为肾细胞癌（RCC）的患者可进行生存分析。RCC队列的中位随访时间（IQR）为36（14 - 56）个月。共有32例患者（6.2%）被诊断为治疗失败。5年/10年DFS分别为90.4%/80.0%，5年/10年OS分别为83.2%/64.4%。共报告134例术后并发症（16.6%），其中26例（3.2%）为严重并发症（≥III级）。美国麻醉医师协会评分为3分与总体并发症风险增加相关（比值比2.85，95%置信区间1.32 - 6.20；P = 0.005）。
这一大型LCA系列研究表明SRM患者长期肿瘤学结局令人满意。然而，尽管LCA被认为是一种微创手术，但在为患者提供咨询时应考虑并发症风险。
