title: Comparison of outcomes in patients undergoing percutaneous renal cryoablation with sedation vs general anesthesia.
abstract: OBJECTIVE
  To compare the efficacy and safety of local anesthesia with conscious sedation (LACS) with general anesthesia (GA) in patients undergoing percutaneous renal cryoablation (PRC) for renal cortical neoplasms.
  
  
  METHODS
  We performed a retrospective review of patients undergoing PRC between 2003 and 2013. Patient demographics, tumor characteristics, and perioperative and postoperative follow-up data were recorded and analyzed. We compared 3 principal outcomes across the GA and LACS groups: anesthesia-related outcomes, treatment failure, and complications.
  
  
  RESULTS
  A total of 235 patients with available data were included. Of these, 82 underwent PRC under GA and 153 patients under LACS. The 2 groups were similar with regard to age, gender, body mass index, American Society of Anesthesiologists score, tumor features, preoperative serum creatinine level, and hematocrit value. The GA and LACS groups had a similar percentage of patients with biopsy-proven renal cell carcinoma (68.5% and 64.2%, respectively; P = .62). The mean follow-up time for GA and LACS was 37 and 21 months, respectively (P <.0001). The mean procedure time for GA was significantly longer compared with LACS (133 vs 102 minutes; P <.001), and the mean hospital stay was shorter under LACS (1.08 vs 1.95 days; P <.0001). There was no difference in immediate failure (0% and 1.9%; P = .051) or recurrences (11% and 3.9%, respectively; P = .051) between GA and LACS groups. There was no difference in intraoperative and postoperative treatment-related complications between the 2 groups.
  
  
  CONCLUSIONS
  PRC for small renal masses under LACS is effective and safe. PRC with LACS has the advantage of decreased procedure time and a shorter hospital stay.
authors.affiliation: Department of Urology, University of California, Irvine, Orange, CA.
authors.forename: Zhamshid
authors.initials: Z
authors.lastname: Okhunov
authors.affiliation: Department of Urology, University of California, Irvine, Orange, CA.
authors.forename: Samuel
authors.initials: S
authors.lastname: Juncal
authors.affiliation: Department of Urology, University of California, Irvine, Orange, CA.
authors.forename: Michael
authors.initials: M
authors.lastname: Ordon
authors.affiliation: The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, NY.
authors.forename: Arvin K
authors.initials: AK
authors.lastname: George
authors.affiliation: Department of Urology, University of California, Irvine, Orange, CA.
authors.forename: Achim
authors.initials: A
authors.lastname: Lusch
authors.affiliation: Department of Urology, University of California, Irvine, Orange, CA.
authors.forename: Michael
authors.initials: M
authors.lastname: del Junco
authors.affiliation: Department of Urology, University of California, Irvine, Orange, CA.
authors.forename: Michael
authors.initials: M
authors.lastname: Nguyentat
authors.affiliation: The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, NY.
authors.forename: Igor I
authors.initials: II
authors.lastname: Lobko
authors.affiliation: The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, NY.
authors.forename: Louis
authors.initials: L
authors.lastname: Kavoussi
authors.affiliation: Department of Urology, University of California, Irvine, Orange, CA. Electronic address: landmanj@uci.edu.
authors.forename: Jaime
authors.initials: J
authors.lastname: Landman
mesh_terms: D000368:Aged; D000768:Anesthesia, General / Q000009:adverse effects; D000772:Anesthesia, Local; D016292:Procedural Sedation / Q000009:adverse effects; D003452:Cryosurgery; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D009392:Nephrectomy / Q000379:methods*; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome