title: Renal cryoablation: outcome at 3 years.
abstract: OBJECTIVE
  We report intermediate term oncological followup data on 56 patients undergoing laparoscopic renal cryoablation, of whom each completed a 3-year followup.
  
  
  METHODS
  Since September 1997, 56 patients undergoing laparoscopic renal cryoablation have completed a followup of 3 years each. The postoperative followup protocol comprised serial magnetic resonance imaging (MRI) at 1 day, months 1, 3, 6, 12, 18 and 24, and yearly thereafter for 5 years. Computerized tomography guided needle biopsy of the cryolesion was performed 6 months postoperatively and repeated if MRI findings were abnormal. Followup data were obtained prospectively.
  
  
  RESULTS
  For a mean renal tumor size of 2.3 cm mean intraoperative size of the created cryolesion was 3.6 cm. Sequential mean cryolesion size on MRI on postoperative 1 day, and at 3 and 6 months, and 1, 2 and 3 years was 3.7, 2.8, 2.3, 1.7, 1.2 and 0.9 cm, representing a 26%, 39%, 56%, 69% and 75% percent reduction in cryolesion size at 3 and 6 months, and 1, 2 and 3 years, respectively. At 3 years 17 cryolesions (38%) had completely disappeared on MRI. Postoperative needle biopsy identified locally persistent/recurrent renal tumor in 2 patients. In the 51 patients undergoing cryotherapy for a unilateral, sporadic renal tumor 3-year cancer specific survival was 98%. There was no open conversion, kidney loss, urinary fistula, dialysis requirement, or perirenal or port site recurrence in any patients.
  
  
  CONCLUSIONS
  Three-year outcomes following renal cryoablation are encouraging. Longer term (5-year) data are necessary to determine the proper place of renal cryotherapy among minimally invasive, nephron sparing options.
authors.affiliation: Section of Laparoscopic and Minimally Invasive Surgery, Glickman Urological Institute and Department of Radiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA. gilli@ccf.org
authors.forename: Inderbir S
authors.initials: IS
authors.lastname: Gill
authors.forename: Erick M
authors.initials: EM
authors.lastname: Remer
authors.forename: Waleed A
authors.initials: WA
authors.lastname: Hasan
authors.forename: Brenda
authors.initials: B
authors.lastname: Strzempkowski
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Spaliviero
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Steinberg
authors.forename: Jihad H
authors.initials: JH
authors.lastname: Kaouk
authors.forename: Mihir M
authors.initials: MM
authors.lastname: Desai
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Novick
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D003452:Cryosurgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000473:pathology; D007677:Kidney Function Tests; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000401:mortality*; D015996:Survival Rate