Henderickx Michaël M E L, Sträter-Ruiter Annebeth E C, van der West Alwine E, Beerlage Harrie P, Zondervan Patricia J, Lagerveld Brunolf W
Department of Urology, Amsterdam University Medical Centers (Amsterdam UMC), University of Amsterdam, Amsterdam, The Netherlands.
Department of Urology, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands.
Arab J Urol. 2020 Dec 17;19(2):159-165. doi: 10.1080/2090598X.2020.1863308.
: To evaluate the oncological outcome at 5-year follow-up after laparoscopic cryoablation (LCA) for small renal masses (SRMs), as there is an increasing interest in ablative therapy for cT1a renal tumours due to the rising incidence of SRMs, the trend towards minimally invasive nephron-sparing treatments, and the ageing population. : Between 2004 and 2015, 233 consecutive LCA were performed in 219 patients for SRMs at two referral centres. We only included those patients with ≥5 years of follow-up ( = 165) in a prospectively maintained database. A descriptive analysis was conducted for pre-, peri- and postoperative characteristics. A Kaplan-Meier analysis assessed overall (OS), disease-specific (DSS), and recurrence-free survival (RFS). : The median (interquartile range [IQR]) age of our patient cohort was 68 (60.5-76) years. The median (IQR) body mass index was 26.2 (23.8-29) kg/m, and the median (IQR) Charlson Comorbidity Index score corrected for age was 4 (2.5-6). The median (IQR) tumour diameter was 28 (21-33) mm. In all, 15% developed a complication in the first 30 days after LCA, of which 1% had a major complication (Clavien-Dindo Grade ≥III). The median (IQR) preoperative estimated glomerular filtration rate (eGFR) was 82.5 (65-93.75) mL/min/1.73 m. The median eGFR decreased by 16.4% and 15.2% at the 3-month and 5-year follow-up, respectively. Persistence was found in 1%, local recurrence in 2%, and systemic progression in 4%. The OS, DSS, and RFS were 74%, 96.9% and 95.4%, respectively. : LCA is a safe and effective treatment for SRMs in selected cases and shows good oncological outcomes after 5 years of follow-up, with only 1% developing a major complication.
为评估小肾肿块（SRMs）腹腔镜冷冻消融术（LCA）后5年随访的肿瘤学结局，鉴于SRMs发病率上升、微创保肾治疗趋势以及人口老龄化，对cT1a肾肿瘤的消融治疗兴趣日益增加。2004年至2015年期间，在两个转诊中心对219例患者连续进行了233次LCA治疗SRMs。我们仅将那些随访时间≥5年（n = 165）的患者纳入前瞻性维护的数据库。对术前、术中和术后特征进行了描述性分析。采用Kaplan-Meier分析评估总生存期（OS）、疾病特异性生存期（DSS）和无复发生存期（RFS）。我们患者队列的中位（四分位间距[IQR]）年龄为68（60.5 - 76）岁。中位（IQR）体重指数为26.2（23.8 - 29）kg/m²，校正年龄后的中位（IQR）Charlson合并症指数评分为4（2.5 - 6）。中位（IQR）肿瘤直径为28（21 - 33）mm。总体而言，15%的患者在LCA后30天内出现并发症，其中1%发生严重并发症（Clavien-Dindo分级≥III级）。术前估计肾小球滤过率（eGFR）的中位（IQR）值为82.5（65 - 93.75）mL/min/1.73 m²。在3个月和5年随访时，eGFR的中位值分别下降了16.4%和15.2%。发现持续存在的占1%，局部复发的占2%，全身进展的占4%。OS、DSS和RFS分别为74%、96.9%和95.4%。LCA在特定病例中是治疗SRMs的一种安全有效的方法，5年随访后显示出良好的肿瘤学结局，只有1%发生严重并发症。
