title: Efficacy of laparoscopic renal cryoablation as an alternative treatment for small renal mass in patients with poor operability: experience from the Korean single center.
abstract: OBJECTIVE
  The aim of this work was to evaluate the efficacy and safety of laparoscopic renal cryoablation (LRC) for the treatment of incidentally found small renal masses in patients with poor operability, from our initial experience in Korea.
  
  
  METHODS
  From June 2005 to April 2009, surgical and oncologic outcomes were evaluated from a database of 45 renal tumors in 39 patients who underwent LRC due to a high American Society of Anesthesiology (ASA) physical status score (i.e., over 3) or old age (i.e., over 70 years old).
  
  
  RESULTS
  Mean (range) age was 63.3 years (range, 43-81), and mean tumor size was 2.5 cm (range 0.7-3.9). Mean of ASA physical status score of whole patients was 2.8 (range, 1-4), and 79.4% (31/39) of patients had an ASA physical status score over 3. Eleven patients (28.2%) were over 70 years old. Among 45 treated lesions, 23 (51.1%) were exophytic tumors, 17 (37.8%) were endophytic tumors, and the other 5 (11.1%) were mesophytic tumors. Mean operating time was 173.7 minutes (range, 110-220), and mean blood loss was 106.3 mL (range, 40-150). None of the patients developed major complications, including adjacent organ injury, collecting system injury, open surgical conversion, or conversion to nephrectomy. Pathologic examination revealed that 60% (27/45) of lesions were renal-cell carcinoma (RCC). During a mean follow-up duration of 23.5 months (range, 6-53), radiologic evidence of tumor recurrence was found in 1 patient (3.7% for RCC). With the exception of this patient, all other patients have remained free of recurrence or metastasis, as determined by a periodic radiologic work-up. Serum creatinine remains stable, with no statistical difference, compared to preoperative levels, in both whole patients and patients with solitary kidney.
  
  
  CONCLUSIONS
  In this series, LRC for small renal tumors showed favorable oncologic and surgical outcomes, including maintenance of renal function, without adverse effects in selected patients with poor operability.
authors.affiliation: Department of Urology, Korea University School of Medicine, Seoul, Korea.
authors.forename: Young Hwii
authors.initials: YH
authors.lastname: Ko
authors.forename: Hoon
authors.initials: H
authors.lastname: Choi
authors.forename: Sung Gu
authors.initials: SG
authors.lastname: Kang
authors.forename: Hong Seok
authors.initials: HS
authors.lastname: Park
authors.forename: Jeong Gu
authors.initials: JG
authors.lastname: Lee
authors.forename: Je Jong
authors.initials: JJ
authors.lastname: Kim
authors.forename: Seok Ho
authors.initials: SH
authors.lastname: Kang
authors.forename: Jun
authors.initials: J
authors.lastname: Cheon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D002292:Carcinoma, Renal Cell / Q000208:ethnology / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D000075202:Contraindications; D003452:Cryosurgery; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000208:ethnology / Q000473:pathology / Q000601:surgery*; D007723:Korea; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D018579:Patient Selection; D012189:Retrospective Studies; D016896:Treatment Outcome