title: Single center experience with percutaneous and laparoscopic cryoablation of small renal masses.
abstract: OBJECTIVE
  While partial nephrectomy remains the gold standard for the management of most small renal masses, increasing experience with renal cryoablation has suggested a viable alternative with a favorable morbidity profile and good efficacy. We report intermediate-term oncologic outcomes from a single-center experience with laparoscopic and percutaneous renal cryoablation.
  
  
  METHODS
  We performed a retrospective review of our laparoscopic renal cryoablation (LRC) and percutaneous renal cryoablation (PRC) experience between January 2003 and April 2007. Patients with at least 12 months of follow-up were included in the analysis. Follow-up consisted of imaging and laboratory studies at regular intervals. Persistent mass enhancement or interval tumor growth was considered a treatment failure.
  
  
  RESULTS
  Sixty-six patients (44% women/56% men; 42% African-American/58% Caucasian/other; mean body mass index, 29.7) with 72 tumors underwent either LRC (n = 52) or PRC (n = 20) with a mean follow-up of 30 months (median 25.1 mos; range 13-63 mos). Average patient age was 66.5 years (range 34-82 yrs). Mean tumor size was 2.33 cm (range 1-4.6 cm). Comorbid conditions were prevalent: 76% hypertension, 36% hyperlipidemia, 24% chronic kidney disease, 29% diabetes mellitus, 36% tobacco use, and 32% heart disease. RESULTS of pretreatment biopsy were 62% renal-cell carcinoma and 38% benign or nondiagnostic. Overall cancer-specific and cancer-free survival were 100% and 97%, respectively. There were two treatment failures (3.8%) in the LRC group and five primary failures in the PRC group (25%) (P = 0.015), four of which were salvaged with repeated PRC with no evidence of recurrence at 6 to 36 months of follow-up. There has been no significant local or metastatic progression.
  
  
  CONCLUSIONS
  LRC and PRC achieved good oncologic control with minimal morbidity at a mean follow-up of 30 months in a patient cohort characterized by numerous comorbid conditions. PRC had a significantly higher primary treatment failure rate than LRC, but re-treatment offered salvage oncologic control with no significant complications.
authors.affiliation: Department of Urology, Eastern Virginia Medical School, Norfolk, Virginia 23510, USA.
authors.forename: John B
authors.initials: JB
authors.lastname: Malcolm
authors.forename: Tristan T
authors.initials: TT
authors.lastname: Berry
authors.forename: Michael B
authors.initials: MB
authors.lastname: Williams
authors.forename: Joshua E
authors.initials: JE
authors.lastname: Logan
authors.forename: Robert W
authors.initials: RW
authors.lastname: Given
authors.forename: Raymond S
authors.initials: RS
authors.lastname: Lance
authors.forename: Bethany
authors.initials: B
authors.lastname: Barone
authors.forename: Sarah
authors.initials: S
authors.lastname: Shaves
authors.forename: Harlan
authors.initials: H
authors.lastname: Vingan
authors.forename: Michael D
authors.initials: MD
authors.lastname: Fabrizio
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003452:Cryosurgery / Q000379:methods*; D003710:Demography; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D017211:Treatment Failure