title: Comparison of laparoscopic and percutaneous cryoablation for treatment of renal masses.
abstract: OBJECTIVE
  To compare perioperative and oncologic outcomes between laparoscopic (LCA) and percutaneous cryoablation (PCA) and identify predictors of treatment failure after cryoablation.
  
  
  METHODS
  Retrospective analysis was performed on 145 patients undergoing LCA and 118 patients undergoing PCA at our institution between July 2000 and June 2011.
  
  
  RESULTS
  LCA and PCA were performed on 167 and 123 tumors, respectively. Perioperative complication rates were 10% for both the groups. Mean length of stay was significantly shorter for the PCA group (2.1 ± 0.5 vs 3.5 ± 3.1 days, P <.01). Both groups had a comparable decline in estimated glomerular filtration rate at most recent follow-up (LCA 3.8 ± 18.5 mL/min/1.73 m(2) vs PCA 6.6 ± 17.1 mL/min/1.73 m(2), P = .21). Mean oncologic follow-up was 71.4 ± 32.1 months for LCA and 38.6 ± 19.6 months for PCA. Kaplan-Meier estimated 5-year overall and recurrence-free survival were 79.3% and 85.5%, respectively, for LCA and 86.3% and 86.3%, respectively, for PCA. Multivariate Cox proportional hazards analysis demonstrated that cryoablation approach (LCA vs PCA) was not predictive of overall mortality or disease recurrence (P = .36 and .82, respectively). Predictors of overall mortality included age-adjusted Charlson comorbidity index ≥ 6 (P = .01) and preoperative estimated glomerular filtration rate <60 mL/min/1.73 m(2) (P = .02). Predictors of recurrence included tumor size ≥ 3 cm (P <.01), body mass index ≥ 30 kg/m(2) (P = .01), and endophytic growth (P = .04).
  
  
  CONCLUSIONS
  Mean length of stay was shorter for patients undergoing PCA as compared with LCA. Complication rates and decline in renal function at most recent follow-up were similar between groups. Oncologic outcomes were influenced by baseline patient and tumor characteristics rather than the cryoablation approach.
authors.affiliation: Division of Urology, Washington University School of Medicine, Saint Louis, MO.
authors.forename: Eric H
authors.initials: EH
authors.lastname: Kim
authors.affiliation: Division of Urology, Washington University School of Medicine, Saint Louis, MO.
authors.forename: Youssef S
authors.initials: YS
authors.lastname: Tanagho
authors.affiliation: Department of Radiology, Washington University School of Medicine, Saint Louis, MO.
authors.forename: Nael E
authors.initials: NE
authors.lastname: Saad
authors.affiliation: Division of Urology, Washington University School of Medicine, Saint Louis, MO.
authors.forename: Sam B
authors.initials: SB
authors.lastname: Bhayani
authors.affiliation: Division of Urology, Washington University School of Medicine, Saint Louis, MO. Electronic address: figenshaur@wudosis.wustl.edu.
authors.forename: R Sherburne
authors.initials: RS
authors.lastname: Figenshau
mesh_terms: D000368:Aged; D003452:Cryosurgery / Q000379:methods; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D012189:Retrospective Studies; D017211:Treatment Failure