title: Decision tree for laparoscopic partial nephrectomy versus laparoscopic renal cryoablation for small renal masses.
abstract: OBJECTIVE
  We propose an algorithm to help guide surgeons' decisions between laparoscopic partial nephrectomy (LPN) and renal laparoscopic cryoablation (LCA) based on preoperative parameters and outcomes defined in the literature.
  
  
  METHODS
  From July 2004 to December of 2007, we performed 51 LPNs and 22 LCAs. We formulated an algorithm between LPN and LCA based on outcomes from published series. Candidates for LPN are younger than 70 years; have few comorbidities; masses < or = 7 cm; and solitary, solid, and or cystic masses with an exophytic or mesophytic location. Candidates for LCA are 70 years old or older, with multiple comorbidities, masses < or = 3.5 cm, multiple masses, solid masses only, and include endophytic or hilar tumors. We then applied this decision tree to our series.
  
  
  RESULTS
  Our results for LPN are statistically similar to the published series except there was a higher positive margin rate in our series (11.8 v 3.5%). Our LCA series had older patients (71 v 65 y), larger masses (3.2 v 2.5 cm), and a higher rate of bleeding necessitating transfusion (18%). We applied the algorithm to all 73 patients in our series. It estimated that 45 patients should undergo LPN and 28 should undergo LCA. A correlation between the predicted surgery and the surgery performed was seen, but approximately one in five patients would have a change in the surgery performed.
  
  
  CONCLUSIONS
  This algorithm validates decisions surgeons are already making between LPN and LCA. While not a perfect model, it can be used to help simplify decisions between these two minimally invasive procedures to achieve optimal outcomes.
authors.affiliation: Department of Urology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California 90027, USA. Alan.A.Nisbet@kp.org
authors.forename: Alan A
authors.initials: AA
authors.lastname: Nisbet
authors.forename: Jocelyn M
authors.initials: JM
authors.lastname: Rieder
authors.forename: Viet Q
authors.initials: VQ
authors.lastname: Tran
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Williams
authors.forename: Gary W
authors.initials: GW
authors.lastname: Chien
mesh_terms: D003452:Cryosurgery / Q000379:methods*; D003663:Decision Trees; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy; D009392:Nephrectomy / Q000379:methods*