title: Long-term oncologic outcomes of laparoscopic renal cryoablation as primary treatment for small renal masses.
abstract: BACKGROUND
  Data regarding long-term oncologic outcomes of laparoscopic renal cryoablation (LRC) as first treatment for small renal masses (SRMs) are lacking. We hypothesized that LRC might provide an effective long-term cancer control in patients with a single cT1a SRM without a previous history of renal cell carcinoma (RCC).
  
  
  METHODS
  The study design was a retrospective analysis of 174 consecutive patients who received LRC as first treatment for a single computed tomography or magnetic resonance imaging contrast-enhancing cT1a SRM between 2000 and 2013. Patients with a previous history of RCC were excluded. Treatment failure was evaluated 1 day after surgery. Local recurrence, metachronous SRM, systemic progression, disease relapse, cancer-specific mortality, and all-cause mortality were evaluated 10 years after surgery. Kaplan-Meier plots were used to depict outcome-free survival rate.
  
  
  RESULTS
  Median patient age was 66 years. Median tumor size was 20mm. Median follow-up was 48 months. Among patients with biopsy-proven RCC (63%, n = 109), the treatment failure-free rate was 98%. The 10-year recurrence-free survival rate was 95% and the 10-year metachronous SRM-free survival rate was 87%. The 10-year systemic progression-free survival rate was 100% and the 10-year disease relapse-free survival rate was 81%. The cancer-specific mortality-free survival rate was 100%, and the all-cause mortality-free survival rate was 61%.
  
  
  CONCLUSIONS
  LRC provides safe long-term cancer control in patients newly diagnosed with a single cT1a SRM. Treatment failure and local recurrence are uncommon. Systemic progression-free survival and cancer-specific-free survival are optimal.
authors.affiliation: Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele Turro, Università Vita-Salute San Raffaele, Milan, Italy; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada. Electronic address: alelarcher@gmail.com.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Larcher
authors.affiliation: Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele Turro, Università Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Fossati
authors.affiliation: Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele Turro, Università Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Mistretta
authors.affiliation: Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele Turro, Università Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Lughezzani
authors.affiliation: Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele Turro, Università Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Giuliana
authors.initials: G
authors.lastname: Lista
authors.affiliation: Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele Turro, Università Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Dell'Oglio
authors.affiliation: Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele Turro, Università Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Abrate
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Karakiewicz
authors.affiliation: Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele Turro, Università Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Nazareno
authors.initials: N
authors.lastname: Suardi
authors.affiliation: Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele Turro, Università Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Lazzeri
authors.affiliation: Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.affiliation: Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele Turro, Università Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Guazzoni
authors.affiliation: Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele Turro, Università Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Nicolò
authors.initials: N
authors.lastname: Buffi
mesh_terms: D000368:Aged; D003452:Cryosurgery / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009367:Neoplasm Staging; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Kidney cancer; Local tumor ablation; Long-term oncologic outcomes; Nephron-sparing surgery; Renal cryoablation; Small renal masses