title: Cryoablation versus minimally invasive partial nephrectomy for small renal masses in the solitary kidney: impact of approach on functional outcomes.
abstract: OBJECTIVE
  We evaluated the change in renal function after renal cryoablation and partial nephrectomy based on tumor complexity according to the R.E.N.A.L. nephrometry score.
  
  
  METHODS
  We retrospectively reviewed the data of patients who had a renal tumor in a solitary kidney, and underwent renal cryoablation and partial nephrectomy between December 2000 and January 2012. Renal tumor complexity was categorized into 3 groups by R.E.N.A.L. nephrometry score as low (4 to 6), intermediate (7 to 9) and high (10 to 12). All baseline demographic data, perioperative parameters and followup data including renal function were collected. Comparisons were made among similar tumor complexities.
  
  
  RESULTS
  In the renal cryoablation and partial nephrectomy groups 29 patients (43 tumors) and 33 patients were identified, respectively. In all renal tumor complexities, renal cryoablation provided a better perioperative outcome in terms of median operative time, estimated blood loss, transfusion, hospital stay and complications. The median change in serum creatinine and estimated glomerular filtration rate was slightly greater in the partial nephrectomy group. However, the differences were not statistically significant for any of the tumor complexities. Three patients (10%) in the renal cryoablation group and 2 (6%) in the partial nephrectomy group required long-term dialysis.
  
  
  CONCLUSIONS
  In patients with solitary kidneys, renal cryoablation is associated with superior perioperative outcomes compared to partial nephrectomy. Specifically, partial nephrectomy is not associated with greater loss of renal function than renal cryoablation regardless of the extent of tumor complexity.
authors.affiliation: Center for Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
authors.forename: Kamol
authors.initials: K
authors.lastname: Panumatrassamee
authors.forename: Jihad H
authors.initials: JH
authors.lastname: Kaouk
authors.forename: Riccardo
authors.initials: R
authors.lastname: Autorino
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Lenis
authors.forename: Humberto
authors.initials: H
authors.lastname: Laydner
authors.forename: Wahib
authors.initials: W
authors.lastname: Isac
authors.forename: Jean-Alexandre
authors.initials: JA
authors.lastname: Long
authors.forename: Remi
authors.initials: R
authors.lastname: Eyraud
authors.forename: Ahmad
authors.initials: A
authors.lastname: Kassab
authors.forename: Ali
authors.initials: A
authors.lastname: Khalifeh
authors.forename: Shahab
authors.initials: S
authors.lastname: Hillyer
authors.forename: Emad
authors.initials: E
authors.lastname: Rizkala
authors.forename: Georges-Pascal
authors.initials: GP
authors.lastname: Haber
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stein
mesh_terms: D003452:Cryosurgery / Q000379:methods*; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome