Laparoscopic cryoablation of solid renal masses: intermediate term followup.
OBJECTIVE
We report our experience with laparoscopic renal cryoablation (LRC) in select cases of small renal neoplasms. We evaluated the oncological results with the advantages of minimally invasive surgery.


METHODS
Since September 2000, at our department 37 patients with a mean age of 64 years (range 29 to 89) have undergone LRC for computerized tomography or magnetic resonance imaging (MRI) documented renal masses. Mean lesion diameter was 25.7 mm (range 10 to 60). According to tumor position in 22 cases the procedure was performed transperitoneally and in 15 it was done retroperitoneoscopically. Postoperative followup included MRI on postoperative day 1, 1, 3, 6, 12, 18 and 24 months after surgery, and annually thereafter. Moreover, 6 months following the surgical procedure biopsy of the site of the treated neoplasm was performed.


RESULTS
The laparoscopic procedure was successfully completed in all cases. Mean operative time was 194 minutes (range 120 to 300) and mean blood loss was 165.3 ml (range 20 to 900). Final histological evaluation revealed renal cell carcinoma in 29 cases and oncocytoma in 6, while 2 were reported as indefinite. All patients were discharged home after a mean of 3.8 days (range 3 to 7) and returned to normal social life after a mean of 7.3 days (range 5 to 9). Early and postoperative complications were evaluated. Mean diameter of the cryolesion on postoperative day 1 on MRI was 48.2 mm and it progressively decreased during followup. Of the 35 patients with at least 6 months of followup computerized tomography guided biopsy was performed in 25, who were negative for neoplasm.


CONCLUSIONS
LRC for small renal masses appears to be a safe, reproducible, minimally invasive technique. Medium term followup in our series is encouraging, although further studies and prolonged followup are needed to access properly the role of this surgical technique.
Cestari
Andrea
A
Department of Urology, San Raffaele Hospital, San Raffaele Turro, Milan, Italy. a_cestari@yahoo.it
Guazzoni
Giorgio
G
dell'Acqua
Vincenzo
V
Nava
Luciano
L
Cardone
Giampiero
G
Balconi
Giuseppe
G
Naspro
Richard
R
Montorsi
Francesco
F
Rigatti
Patrizio
P
D018249:Adenoma, Oxyphilic / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D003452:Cryosurgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000473:pathology / Q000601:surgery; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D014057:Tomography, X-Ray Computed