title: Laparoscopic vs percutaneous cryoablation for the small renal mass: 15-year experience at a single center.
abstract: OBJECTIVE
  To analyze our 15-year experience with small renal masses ablation and present oncologic and functional outcomes of laparoscopic cryoablation (LCA) and percutaneous cryoablation (PCA).
  
  
  METHODS
  We identified patients who underwent LCA (n = 275) or PCA (n = 137) for small renal masses between 1997 and 2012. Differences in overall survival (OS) and recurrence-free survival (RFS) were analyzed using a log-rank test. Cox proportional hazard ratios model was used to determine factors that predicted OS. Fit proportional hazard risk ratios were also calculated to determine if there were any factors that affected tumor recurrence.
  
  
  RESULTS
  Tumor sizes were equal between the 2 groups; however, tumors in the PCA group were more complex. The overall (7.27% and 7.29%) and major complications (0.7% and 3.6%) were similar. The estimated probability of 5-year OS for LCA and PCA was 89% and 82%, respectively. The estimated probability of the 5-year RFS for LCA and PCA was 79% and 80%, respectively. Heart disease (hazard ratio, 2.15; 95% confidence interval, 1.35-3.41; P = .001) and history of disease recurrence (hazard ratio, 2.49; 95% confidence interval, 1.60-3.86; P = .001; P <.0001) were predictors of death. The median follow-up time for the LCA group (4.41 years [1.67-6.91 years]) was longer than the PCA group (3.15 years [1.37-4.08 years]; P = .0001).
  
  
  CONCLUSIONS
  We found no significant difference in OS or RFS at 5 years between the 2 groups. Tumor size and anterior location affected local recurrence rates, and these factors should be taken into consideration when choosing the appropriate treatment plan. RENAL nephrometry score or type of cryoablation was not associated with tumor recurrence.
authors.affiliation: Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Homayoun
authors.initials: H
authors.lastname: Zargar
authors.affiliation: Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Samarasekera
authors.affiliation: Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Ali
authors.initials: A
authors.lastname: Khalifeh
authors.affiliation: Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, OH.
authors.forename: Erick M
authors.initials: EM
authors.lastname: Remer
authors.affiliation: Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, OH.
authors.forename: Charles
authors.initials: C
authors.lastname: O'Malley
authors.affiliation: Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Oktay
authors.initials: O
authors.lastname: Akca
authors.affiliation: Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Autorino
authors.affiliation: Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH. Electronic address: kaoukj@ccf.org.
authors.forename: Jihad H
authors.initials: JH
authors.lastname: Kaouk
mesh_terms: D018249:Adenoma, Oxyphilic / Q000473:pathology / Q000601:surgery*; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000556:secondary / Q000601:surgery*; D003452:Cryosurgery / Q000009:adverse effects / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery; D015996:Survival Rate; D047368:Tumor Burden