Laparoscopic partial nephrectomy versus laparoscopic cryoablation for multiple ipsilateral renal tumors.
BACKGROUND
Management of multiple ipsilateral renal tumors is a dilemma in clinical practice. The effects of minimally invasive nephron-sparing procedures in this group of patients have not been assessed.


OBJECTIVE
To evaluate the technical feasibility and outcomes of laparoscopic partial nephrectomy (LPN) and laparoscopic cryoablation (LCA) for multiple ipsilateral renal tumors.


METHODS
Between September 1999 and December 2006, 27 patients were treated with minimally invasive nephron sparing surgery (LPN or LCA) for synchronous multiple ipsilateral renal tumors in a single operating session at our institution. Fourteen patients with 28 tumors underwent LPN, and 13 patients with 31 tumors underwent LCA as the sole treatment modality.


METHODS
Medical records were retrospectively reviewed and data were collected.


METHODS
Demographic, intraoperative, postoperative, and intermediate-term follow-up data were compared between the two groups.


CONCLUSIONS
Patients in the LPN group had fewer tumors (2 vs. 2.4, p=0.04) and larger dominant tumor size (3.6 vs. 2.5 cm, p=0.005) in the affected kidney and lower preoperative serum creatinine levels (1 vs. 1.4 mg/dl, p=0.02). Compared to the LCA group, patients in the LPN group had greater estimated blood loss (200 vs. 125 ml, p=0.02) and longer hospital stays (90 vs. 52.3h, p=0.02). There were no open conversions, and no kidneys were lost. Complication rate, renal functional outcomes, and intermediate-term cancer-specific survival rates were similar between the two groups.


CONCLUSIONS
Both LPN and LCA are viable options for patients with multiple ipsilateral renal tumors in select patients. Renal functional outcomes, complication rates, and intermediate-term survival rates are comparable between the two groups in this small series.
Lin
Yi-Chia
YC
Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, Cleveland Clinic Foundation, A-100, Cleveland, OH 44195, USA.
Turna
Burak
B
Frota
Rodrigo
R
Aron
Monish
M
Haber
Georges-Pascal
GP
Kamoi
Kazumi
K
Koenig
Philippe
P
Gill
Inderbir S
IS
D000328:Adult; D000368:Aged; D003452:Cryosurgery / Q000379:methods*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies