title: Evaluation of costs and morbidity associated with laparoscopic radiofrequency ablation and laparoscopic partial nephrectomy for treating small renal tumours.
abstract: OBJECTIVE
  To compare the costs and morbidity of laparoscopic radiofrequency ablation (LRFA) and laparoscopic partial nephrectomy (LPN) for treating small localized renal tumours.
  
  
  METHODS
  We retrospectively analysed the outcomes of 88 patients treated at our institution for a renal tumour either by LPN (50) or LRFA (38) between March 2000 and May 2006. Patients with multiple tumours, combined LRFA and LPN, and those who had other simultaneous surgical procedures were excluded. Clinical variables and outcomes were analysed for each patient. Direct cost data were available for 40 patients treated with LPN and 14 with LRFA. Continuous and categorical variables were compared using an independent t-test and chi-square test, respectively.
  
  
  RESULTS
  The tumour size was comparable in each group; patients in the LRFA group had more comorbidities (P = 0.01) and a higher overall mortality rate (P = 0.01) but no patient died from cancer. Operative duration, estimated blood loss and length of stay were significantly shorter in the LRFA group but there was no difference in complication rate. LRFA was less costly than LPN ($6103 vs $6808, P = 0.3) but not statistically significantly. The cost savings from the shorter operative duration and length of stay were reduced by the cost of probe. With a median follow-up of 20 months there was no difference in oncological outcome.
  
  
  CONCLUSIONS
  Patients undergoing LRFA tend to be older and have more comorbidities than those treated with LPN. The cost is minimally lower for LRFA, secondary to the added cost of the probe. LRFA might be a good alternative treatment in patients at higher risk of surgical complications, but LPN provides good results when done by an experienced surgeon.
authors.affiliation: Department of Urology, University of Texas South-western Medical Center at Dallas, Dallas, Texas 75390-9110, USA.
authors.forename: Karim
authors.initials: K
authors.lastname: Bensalah
authors.forename: Ilia
authors.initials: I
authors.lastname: Zeltser
authors.forename: Altug
authors.initials: A
authors.lastname: Tuncel
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Cadeddu
authors.forename: Yair
authors.initials: Y
authors.lastname: Lotan
mesh_terms: D017115:Catheter Ablation / Q000009:adverse effects / Q000191:economics / Q000592:standards*; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000191:economics / Q000601:surgery*; D010535:Laparoscopy / Q000191:economics / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000191:economics / Q000592:standards*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D016896:Treatment Outcome