title: Second prize: Recurrence rates after percutaneous and laparoscopic renal cryoablation of small renal masses: does the approach make a difference?
abstract: OBJECTIVE
  As radiologic detection of small renal masses increases, patients are increasingly offered percutaneous renal cryoablation (PRC) or transperitoneal laparoscopic renal cryoablation (TLRC). This multicenter experience compares these approaches.
  
  
  METHODS
  Between September 1998 and May 2010, review of our PRC and TLRC experience was performed. Patients with ≥ 12-month follow-up were included for analysis. Post-treatment surveillance consisted of laboratory studies and imaging at regular intervals. Treatment failure was considered if persistent mass enhancement or interval tumor growth was radiographically evident. Repeated biopsy and re-treatment were recommended in the event of recurrence.
  
  
  RESULTS
  Sixty-one patients underwent PRC and 84 patients underwent TLRC. No significant differences were noted with respect to demographic factors. Mean tumor size was 2.7 ± 1.1 cm (PRC) and 2.5 ± 0.8 (TLRC) cm (P = 0.090). Mean follow-up was 31.0 ± 15.9 months (PRC) and 42.3 ± 21.2 (TLRC) months (P = 0.008), with local tumor recurrence noted in 10/61 (16.4%) PRC and 5/84 (5.9%) TLRC (P = 0.042). For PRC, disease-free survival (DFS) and overall survival (OS) were 93.7% and 88.9%, respectively, with four patients having evidence of disease at last follow-up. DFS and OS were 91.7% and 89.3% for TLRC, with seven patients having evidence of disease at last follow-up. DFS (P = 0.654) and OS (P = 0.939) were similar.
  
  
  CONCLUSIONS
  In this multicenter study of well-matched cohorts, PRC had higher primary treatment failure rates than TLRC. While no differences were noted between DFS and OS, analysis is limited by intermediate follow-up. Further study is necessary to discern reasons for the higher recurrence rates in PRC and to determine what long-term consequences exist.
authors.affiliation: Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104, USA. kurt-strom@ouhsc.edu
authors.forename: Kurt H
authors.initials: KH
authors.lastname: Strom
authors.forename: Ithaar
authors.initials: I
authors.lastname: Derweesh
authors.forename: Sean P
authors.initials: SP
authors.lastname: Stroup
authors.forename: John B
authors.initials: JB
authors.lastname: Malcolm
authors.forename: James
authors.initials: J
authors.lastname: L'Esperance
authors.forename: Robert W
authors.initials: RW
authors.lastname: Wake
authors.forename: Robert
authors.initials: R
authors.lastname: Gold
authors.forename: Michael
authors.initials: M
authors.lastname: Fabrizio
authors.forename: Kerrin
authors.initials: K
authors.lastname: Palazzi-Churas
authors.forename: Xiao
authors.initials: X
authors.lastname: Gu
authors.forename: Carson
authors.initials: C
authors.lastname: Wong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001363:Awards and Prizes; D003452:Cryosurgery / Q000379:methods*; D003710:Demography; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000473:pathology / Q000601:surgery*; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D012008:Recurrence; D016896:Treatment Outcome