Laparoscopic versus Percutaneous Cryoablation for the Small Renal Mass: Long-term Oncologic and Functional Outcomes
CUA Online Library. Samarasekera D. 06/24/13; 31264; MP-03.07
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Abstract
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Introduction and Objectives: We previously described a comparative analysis of over 300 patients undergoing either laparoscopic (LCA) or percutaneous renal cryoablation (PCA) for an enhancing renal mass between 1997 and 2008. Both LCA and PCA were found to have good short-term oncologic efficacy and preservation of renal function. However PCA was found to have a higher incomplete treatment rate (7.6% vs 1.6%, p=0.0055) compared to LCA. We present our updated analysis with a longer follow-up period.
Methods: A retrospective cohort analysis of our thermal ablation database was performed. We identified 385 patients who underwent either LCA (n=255) or PCA (n= 130) for an enhancing renal mass between 1997 and 2012. Demographics, baseline clinical characteristics, functional, and oncologic outcomes were analyzed. All patients were followed by a standard protocol which included serial post-operative imaging. Renal functional outcomes were measured by absolute serum creatinine and estimated glomerular filtration rate (eGFR).
Results: There was no difference in patient demographics, clinical parameters, and tumor characteristics at baseline (p > 0.05). However, there was a significantly higher number of patients who underwent PCA who had heart disease at baseline. Mean tumor size was 2.5 ± 0.99 cm for the LCA group and 2.41 ± 0.92 cm for the PCA group (p= 0.15). Patients who underwent PCA were more likely to have a solitary kidney (48/152 vs 49/267, p = 0.002). Mean follow-up was 51.1 ± 42.4 months for LCA versus 28.3 ± 20.0 months for PCA (p < 0.001). Mean eGFR at latest follow-up was 55.8 ± 28.5 versus 57.7 ± 24.7 mL/min/1.73 m2 (p=0.49) for LCA and PCA respectively. Five-year overall, cancer specific, recurrence free, and metastasis-free survival rates for LCA vs PCA were 76.1% vs 56%, 95.6% vs 98.8%, 78.6% vs 84.8%, and 91% vs 79%, respectively. The rate of incomplete treatment was 10.5% (28/267) for LCA and 15.8% (24/152) for PCA (p=0.099).
Conclusions: We present our long-term comparative analysis of LCA and PCA. There was a significant difference in overall survival favoring LCA, but no difference in cancer specific survival. This was likely due to selection bias, as a higher proportion of patients in the PCA group had heart disease and were not fit for a general anesthetic. There was also a higher rate of incomplete treatment in the PCA group. This was seen in our previous analysis, and is echoed in other series in the literature. However, both methods are associated with acceptable efficacy and can be utilized as an alternative first-line treatment for select patients who are deemed unsuitable for extirpative surgical therapy.
Methods: A retrospective cohort analysis of our thermal ablation database was performed. We identified 385 patients who underwent either LCA (n=255) or PCA (n= 130) for an enhancing renal mass between 1997 and 2012. Demographics, baseline clinical characteristics, functional, and oncologic outcomes were analyzed. All patients were followed by a standard protocol which included serial post-operative imaging. Renal functional outcomes were measured by absolute serum creatinine and estimated glomerular filtration rate (eGFR).
Results: There was no difference in patient demographics, clinical parameters, and tumor characteristics at baseline (p > 0.05). However, there was a significantly higher number of patients who underwent PCA who had heart disease at baseline. Mean tumor size was 2.5 ± 0.99 cm for the LCA group and 2.41 ± 0.92 cm for the PCA group (p= 0.15). Patients who underwent PCA were more likely to have a solitary kidney (48/152 vs 49/267, p = 0.002). Mean follow-up was 51.1 ± 42.4 months for LCA versus 28.3 ± 20.0 months for PCA (p < 0.001). Mean eGFR at latest follow-up was 55.8 ± 28.5 versus 57.7 ± 24.7 mL/min/1.73 m2 (p=0.49) for LCA and PCA respectively. Five-year overall, cancer specific, recurrence free, and metastasis-free survival rates for LCA vs PCA were 76.1% vs 56%, 95.6% vs 98.8%, 78.6% vs 84.8%, and 91% vs 79%, respectively. The rate of incomplete treatment was 10.5% (28/267) for LCA and 15.8% (24/152) for PCA (p=0.099).
Conclusions: We present our long-term comparative analysis of LCA and PCA. There was a significant difference in overall survival favoring LCA, but no difference in cancer specific survival. This was likely due to selection bias, as a higher proportion of patients in the PCA group had heart disease and were not fit for a general anesthetic. There was also a higher rate of incomplete treatment in the PCA group. This was seen in our previous analysis, and is echoed in other series in the literature. However, both methods are associated with acceptable efficacy and can be utilized as an alternative first-line treatment for select patients who are deemed unsuitable for extirpative surgical therapy.
Introduction and Objectives: We previously described a comparative analysis of over 300 patients undergoing either laparoscopic (LCA) or percutaneous renal cryoablation (PCA) for an enhancing renal mass between 1997 and 2008. Both LCA and PCA were found to have good short-term oncologic efficacy and preservation of renal function. However PCA was found to have a higher incomplete treatment rate (7.6% vs 1.6%, p=0.0055) compared to LCA. We present our updated analysis with a longer follow-up period.
Methods: A retrospective cohort analysis of our thermal ablation database was performed. We identified 385 patients who underwent either LCA (n=255) or PCA (n= 130) for an enhancing renal mass between 1997 and 2012. Demographics, baseline clinical characteristics, functional, and oncologic outcomes were analyzed. All patients were followed by a standard protocol which included serial post-operative imaging. Renal functional outcomes were measured by absolute serum creatinine and estimated glomerular filtration rate (eGFR).
Results: There was no difference in patient demographics, clinical parameters, and tumor characteristics at baseline (p > 0.05). However, there was a significantly higher number of patients who underwent PCA who had heart disease at baseline. Mean tumor size was 2.5 ± 0.99 cm for the LCA group and 2.41 ± 0.92 cm for the PCA group (p= 0.15). Patients who underwent PCA were more likely to have a solitary kidney (48/152 vs 49/267, p = 0.002). Mean follow-up was 51.1 ± 42.4 months for LCA versus 28.3 ± 20.0 months for PCA (p < 0.001). Mean eGFR at latest follow-up was 55.8 ± 28.5 versus 57.7 ± 24.7 mL/min/1.73 m2 (p=0.49) for LCA and PCA respectively. Five-year overall, cancer specific, recurrence free, and metastasis-free survival rates for LCA vs PCA were 76.1% vs 56%, 95.6% vs 98.8%, 78.6% vs 84.8%, and 91% vs 79%, respectively. The rate of incomplete treatment was 10.5% (28/267) for LCA and 15.8% (24/152) for PCA (p=0.099).
Conclusions: We present our long-term comparative analysis of LCA and PCA. There was a significant difference in overall survival favoring LCA, but no difference in cancer specific survival. This was likely due to selection bias, as a higher proportion of patients in the PCA group had heart disease and were not fit for a general anesthetic. There was also a higher rate of incomplete treatment in the PCA group. This was seen in our previous analysis, and is echoed in other series in the literature. However, both methods are associated with acceptable efficacy and can be utilized as an alternative first-line treatment for select patients who are deemed unsuitable for extirpative surgical therapy.
Methods: A retrospective cohort analysis of our thermal ablation database was performed. We identified 385 patients who underwent either LCA (n=255) or PCA (n= 130) for an enhancing renal mass between 1997 and 2012. Demographics, baseline clinical characteristics, functional, and oncologic outcomes were analyzed. All patients were followed by a standard protocol which included serial post-operative imaging. Renal functional outcomes were measured by absolute serum creatinine and estimated glomerular filtration rate (eGFR).
Results: There was no difference in patient demographics, clinical parameters, and tumor characteristics at baseline (p > 0.05). However, there was a significantly higher number of patients who underwent PCA who had heart disease at baseline. Mean tumor size was 2.5 ± 0.99 cm for the LCA group and 2.41 ± 0.92 cm for the PCA group (p= 0.15). Patients who underwent PCA were more likely to have a solitary kidney (48/152 vs 49/267, p = 0.002). Mean follow-up was 51.1 ± 42.4 months for LCA versus 28.3 ± 20.0 months for PCA (p < 0.001). Mean eGFR at latest follow-up was 55.8 ± 28.5 versus 57.7 ± 24.7 mL/min/1.73 m2 (p=0.49) for LCA and PCA respectively. Five-year overall, cancer specific, recurrence free, and metastasis-free survival rates for LCA vs PCA were 76.1% vs 56%, 95.6% vs 98.8%, 78.6% vs 84.8%, and 91% vs 79%, respectively. The rate of incomplete treatment was 10.5% (28/267) for LCA and 15.8% (24/152) for PCA (p=0.099).
Conclusions: We present our long-term comparative analysis of LCA and PCA. There was a significant difference in overall survival favoring LCA, but no difference in cancer specific survival. This was likely due to selection bias, as a higher proportion of patients in the PCA group had heart disease and were not fit for a general anesthetic. There was also a higher rate of incomplete treatment in the PCA group. This was seen in our previous analysis, and is echoed in other series in the literature. However, both methods are associated with acceptable efficacy and can be utilized as an alternative first-line treatment for select patients who are deemed unsuitable for extirpative surgical therapy.
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