title: Comparison of Renal Parenchymal Volume Preservation Between Partial Nephrectomy, Cryoablation, and Radiofrequency Ablation Using 3D Volume Measurements.
abstract: OBJECTIVE
  Small renal masses (SRM) can be managed via a variety of nephron-sparing procedures (NSPs), but the association between choice of NSP and renal parenchymal volume (RPV) preservation is not well understood. We sought to examine RPV preservation after partial nephrectomy (PN) performed via open, robotic, or laparoscopic approaches and thermal ablation (TA) performed via cryoablation (CA) or radiofrequency ablation (RFA).
  
  
  METHODS
  The study was a retrospective review of three institutional databases of patients with a SRM <4 cm treated via one of the five NSPs (open PN, laparoscopic PN, robotic PN, percutaneous CA, or percutaneous RFA). The 30 most recent consecutive cases treated via each NSP were selected to obtain a total of 150 cases for analysis. Patient characteristics were obtained via manual chart review, and tumor characteristics were assessed via the R.E.N.A.L. nephrometry score. Using three-dimensional rendering software, preoperative and postoperative RPV was calculated for the tumor-bearing kidney, excluding the tumor itself (for preoperative images) or the postsurgical/ablative defect (for postoperative images). The percent change in RPV was compared between the procedure types.
  
  
  RESULTS
  One hundred fifty cases were included in the final analysis, with 30 cases from each NSP category. While preoperative tumors were larger in the PN group, there was no difference in the mean nephrometry score between groups. The TA group was found to have a lower mean RPV loss (-8.1% vs -16.5%, p<0.005). There was no difference in the RPV loss between modalities of TA (CA vs RFA) or between approaches to PN (open, laparoscopic, robotic). Matched-pair analysis based on the tumor size and multivariate analysis indicated TA vs PN was independently associated with less RPV loss.
  
  
  CONCLUSIONS
  TA is associated with less RPV loss than PN in the management of SRM, but there is no difference between modalities of TA (CA vs RFA) or between approaches to PN.
authors.affiliation: 1 Department of Urology, Columbia University Medical Center, New York, New York.
authors.forename: Solomon L
authors.initials: SL
authors.lastname: Woldu
authors.affiliation: 4 Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Gregory R
authors.initials: GR
authors.lastname: Thoreson
authors.affiliation: 5 Department of Urology, University of California Irvine Medical Center, Irvine, California.
authors.forename: Zhamshid
authors.initials: Z
authors.lastname: Okhunov
authors.affiliation: 1 Department of Urology, Columbia University Medical Center, New York, New York.
authors.forename: Rashed
authors.initials: R
authors.lastname: Ghandour
authors.affiliation: 1 Department of Urology, Columbia University Medical Center, New York, New York.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Rothberg
authors.affiliation: 3 Department of Biostatistics, Columbia University Medical Center, New York, New York.
authors.forename: Arindam
authors.initials: A
authors.lastname: RoyChoudhury
authors.affiliation: 6 Department of Radiology, University of California Irvine Medical Center, Irvine, California.
authors.forename: Helen H R
authors.initials: HH
authors.lastname: Kim
authors.affiliation: 6 Department of Radiology, University of California Irvine Medical Center, Irvine, California.
authors.forename: Mari
authors.initials: M
authors.lastname: Bozoghlanian
authors.affiliation: 2 Department of Radiology, Columbia University Medical Center, New York, New York.
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Newhouse
authors.affiliation: 6 Department of Radiology, University of California Irvine Medical Center, Irvine, California.
authors.forename: Mohammad A
authors.initials: MA
authors.lastname: Helmy
authors.affiliation: 1 Department of Urology, Columbia University Medical Center, New York, New York.
authors.forename: Ketan K
authors.initials: KK
authors.lastname: Badani
authors.affiliation: 5 Department of Urology, University of California Irvine Medical Center, Irvine, California.
authors.forename: Jamie
authors.initials: J
authors.lastname: Landman
authors.affiliation: 4 Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Cadeddu
authors.affiliation: 6 Department of Radiology, University of California Irvine Medical Center, Irvine, California.
authors.forename: James M
authors.initials: JM
authors.lastname: McKiernan
mesh_terms: D000328:Adult; D000368:Aged; D017115:Catheter Ablation / Q000379:methods*; D003452:Cryosurgery / Q000379:methods*; D005260:Female; D006801:Humans; D007668:Kidney / Q000601:surgery; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009392:Nephrectomy / Q000379:methods*; D009399:Nephrons / Q000601:surgery; D059351:Organ Sparing Treatments / Q000379:methods*; D011184:Postoperative Period; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods