title: Laparoscopic cryotherapy for small renal masses: Current State.
abstract: OBJECTIVE
  To provide an up-to-date review of the available literature on laparoscopic cryotherapy for small renal masses  (SRMs)  including technique description, indications and outcomes.
  
  
  METHODS
  A systematic literature search was conducted in March 2012, using MEDLINE and EMBASE via Ovid databases, to identify studies on laparoscopic  cryotherapy for SRMs published during the last 10 years. Only English-language and human-based full manuscripts reporting case series studies  with >20  participants, patient characteristics, efficacy and safety data were included.
  
  
  RESULTS
  No randomised controlled trials (RCTs)were identified. In total, 27 full reports addressing laparoscopic cryoablation (LCA)  for SRMs were  selected. The number of patients per study ranged from 20 to 144. Mean age of treated patients across the series ranged from 62 to 73 years. Mean  size of renal tumors ranged from 2.7 to 4 cm, being in most cases <3 cm. The number of cryoprobes used for cryoablation ranged from 1 to 6,  and only 10 series described the use of 17-gauge (1.47 mm) third-generation needles. Overall, more than 55% of all ablated  lesions  were  pathologically confirmed RCC. Mean follow-up ranged from 9 to 93 months. Only 7 series presented a long-term follow-up of more than 36 months. Most studies were  limited by a  relatively short follow-up. At least four urologic groups reported intermediate- and long-term outcomes. Persistence rates ranged  from 0% to 17% and recurrence rates ranged from 0% to 14%. Overall complication rates ranged from 0% to 40%.
  
  
  CONCLUSIONS
  Retrospective observational data and a few prospective series on LCA of SRMs show acceptable oncological 3- to 5-year outcomes  with a  low recurrence rate. It has proven to be a safe procedure with an overall low complication rate. It is mainly indicated for SRMs in elderly patients  affected by co-morbidity and high surgical risk bearing tumours in the anterior valve of the kidney or in contact with the ureter or neighbouring  organs.
authors: Servicio de Urologúa, Hospital AMC, Amsterdam, Holanda. ercordeiro@hotmail.com
authors: E R
authors: ER
authors: Cordeiro
authors: K
authors: K
authors: Barwari
authors: A
authors: A
authors: Anastasiadis
authors: M
authors: M
authors: García
authors: F
authors: F
authors: Branco
authors: J J
authors: JJ
authors: de la Rosette
authors: M P
authors: MP
authors: Laguna
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D017679:Cryotherapy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult