title: Perioperative, oncologic, and functional outcomes of laparoscopic renal cryoablation and open partial nephrectomy: a matched pair analysis.
abstract: OBJECTIVE
  To directly compare perioperative, oncologic, and functional outcomes of laparoscopic renal cryoablation and open partial nephrectomy using a matched pair analysis.
  
  
  METHODS
  A total of 41 patients who underwent laparoscopic cryoablation for an incidental, solid clinical T(1a)N(0)M(0) renal tumor were matched with 82 patients who received partial nephrectomy in cold ischemia, using optimal matching based on propensity scores, which were created on the basis of preoperative aspects and dimensions used for an anatomic classification of renal tumors (PADUA) score, preoperative glomerular filtration rate, age-adjusted Charlson comorbidity index, and sex. Median follow-up was 33.6 months.
  
  
  RESULTS
  No differences in the overall incidence of complications (cryoablation, 20%; partial nephrectomy, 17%; P=0.739) and grade of complications (P=0.424) were observed. After cryoablation, local recurrence developed in four patients with renal-cell carcinoma (n=35) after a median duration of 14 months (range 6-18  mos), but none after partial nephrectomy. The 3-year recurrence-free survival probabilities after laparoscopic renal cryoablation vs open partial nephrectomy were 83% vs 100%, respectively (P=0.015). The average decrease of estimated glomerular filtration rate during follow-up was 7.8±3.1  mL/min/1.73  m(2) after laparoscopic cryoablation and 9.8±2.3  mL/min/1.73  m(2) after open partial nephrectomy, which was not statistically significant (P=0.602).
  
  
  CONCLUSIONS
  Perioperative complications and renal functional outcomes of laparoscopic cryoablation and open partial nephrectomy are similar; however, laparoscopic cryoablation confers a substantially higher local recurrence risk of about 17% after 3 years. Therefore, laparoscopic renal cryoablation should be reserved for high-risk patients with decreased life expectancy. Careful patient counseling is advocated. Study limitations include the small sample size, the lack of randomization, and the short follow-up.
authors.affiliation: Department of Urology, Medical University of Vienna, Vienna, Austria. tobias.klatte@gmx.de
authors.forename: Tobias
authors.initials: T
authors.lastname: Klatte
authors.forename: Julian
authors.initials: J
authors.lastname: Mauermann
authors.forename: Gertraud
authors.initials: G
authors.lastname: Heinz-Peer
authors.forename: Matthias
authors.initials: M
authors.lastname: Waldert
authors.forename: Peter
authors.initials: P
authors.lastname: Weibl
authors.forename: Hans Christoph
authors.initials: HC
authors.lastname: Klingler
authors.forename: Mesut
authors.initials: M
authors.lastname: Remzi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003452:Cryosurgery / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology / Q000601:surgery*; D007680:Kidney Neoplasms / Q000503:physiopathology* / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D019990:Perioperative Care; D016896:Treatment Outcome