Laparoscopic cryoablation for small renal masses: three-year follow-up.
OBJECTIVE
To report our experience with laparoscopic renal cryoablation for patients who have completed a minimum of 3 years of follow-up.


METHODS
From July 2000 to March 2005, 81 patients underwent laparoscopic renal cryoablation for renal masses. Of these 81 patients, 31 (38%) underwent laparoscopic renal cryoablation for 36 tumors and have completed a minimal follow-up of 3 years (mean 45.7 months). The postoperative follow-up protocol consisted of serial contrast-enhanced computed tomography or magnetic resonance imaging at 1 day, 1, 3, 6, and 12 months, and yearly thereafter.


RESULTS
Twenty-seven tumors were partially exophytic, five were totally endophytic, and four were hilar tumors. The mean operative time was 2.9 hours, with a mean estimated blood loss of 97 mL. The mean renal tumor size was 2.1 cm. In early follow-up, the ablation zone was larger than the tumor but subsequently diminished to the original tumor size 6 months postoperatively. Thereafter, the ablation zone size decreased. The biopsy results revealed that 22 tumors (61%) were malignant and 14 (39%) were benign. The renal tumor 3-year cancer-specific survival rate was 100%, and no patient developed metastatic disease. One patient demonstrated return of abnormal enhancement within the cryolesion during follow-up, suggesting tumor recurrence. One patient had a hemorrhage and urinary leak after cryoablation of an endophytic tumor and was treated conservatively.


CONCLUSIONS
Renal cryoablation is safe and offers a minimally invasive nephron-sparing alternative. The oncologic adequacy of renal cryoablation requires long-term follow-up data, but the intermediate-term data seem equivalent to that achieved with extirpative therapy.
Weld
Kyle J
KJ
Division of Urology, Washington University School of Medicine, St. Louis, Missouri, USA.
Figenshau
Robert S
RS
Venkatesh
Ramakrishna
R
Bhayani
Sam B
SB
Ames
Caroline D
CD
Clayman
Ralph V
RV
Landman
Jaime
J
D000328:Adult; D015897:Comorbidity; D003452:Cryosurgery / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000453:epidemiology / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged