title: Laparoscopic partial nephrectomy versus laparoscopic ablative therapy: a comparison of surgical and functional outcomes in a matched control study.
abstract: OBJECTIVE
  Patients who are undergoing laparoscopic ablative therapy (LAT) are often older with more comorbidities in comparison with patients who are undergoing laparoscopic partial nephrectomy (LPN). A matched control study was performed to compare the surgical and functional outcomes of LPN and LAT.
  
  
  METHODS
  A prospectively maintained database of 250 patients who underwent nephron-sparing surgery was explored. Fifty-one LAT patients (21 and 30 laparoscopic radiofrequency and cryoablation, respectively) were matched with 51 LPN patients. A comparison of preoperative, operative, and postoperative outcomes was performed.
  
  
  RESULTS
  The groups were similar in age, sex, body mass index, preoperative estimated glomerular filtration rate (eGFR), number of comorbidities and tumor size. Patients who were undergoing LAT had a lower incidence of endophytic tumor and higher incidence of upper pole and midpolar tumors. Hilar vessels clamping was performed in LPN (47/51 patients). Mean estimated blood loss and operative time were higher in those undergoing LPN (P<0.01). There was no significant difference in transfusion rate and hospital stay, however. Mean follow-up was 27 and 18 months in LAT and LPN, respectively (P<0.01). The mean percent decline of eGFR at the last follow-up was 10 (95% confidence interval [CI]: 4-15) and 7.5 (95% CI: 4-11), respectively (P<0.43). In comparison with baseline, eGFR declined significantly (P<0. 01), but there was no difference between the groups.
  
  
  CONCLUSIONS
  Despite renal ischemia, longer operative time, and higher blood loss associated with LPN, the hospital stay and long-term functional outcomes are similar to those of LAT in a matched control study.
authors: Section of Urology, Department of Surgery, University of Chicago Medical Center, Chicago, Illinois, USA. kkiriluk@gmail.com
authors: Kyle J
authors: KJ
authors: Kiriluk
authors: Sergey A
authors: SA
authors: Shikanov
authors: Gary D
authors: GD
authors: Steinberg
authors: Arieh L
authors: AL
authors: Shalhav
authors: David A
authors: DA
authors: Lifshitz
mesh_terms: D055011:Ablation Techniques / Q000379:methods*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007677:Kidney Function Tests; D007680:Kidney Neoplasms / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D011300:Preoperative Care; D016896:Treatment Outcome; D055815:Young Adult