NEW ORLEANS, LA USA (UroToday.com) - Introduction and Objectives: The increased application of imaging technologies has resulted in an increased incidence of small renal masses and a stage migration in renal cancer. Cryoablation has emerged as a treatment option, but there remains a scarcity of intermediate and long-term follow-up results. We present the 5-year follow up data of an international multi-institutional experience.
Methods: After institutional board approval we reviewed data for patients who underwent laparoscopic or percutaneous cryoablation at 8 academic institutions internationally from 2004–2007 with a focus on patients with a minimum of 5 years follow-up. Patient demographics, perioperative outcomes, and oncologic outcomes were retrospectively recorded. Statistical analysis was performed with SPSS v10 (SPSS, IBM Corporation, Armonk, New York) and a p-value < 0.05 was considered as statistical significant.
Results: A total of 256 patients were available for evaluation, 149 patients had a minimum of 5 year follow up [mean 69.4 months, range 60–106 month]. The mean age was 66.9 years with a mean body mass index (BMI) of 27.8 and a median American Society of Anesthesiologists score (ASA) of 3. Percutaneous cryoablation was performed on 31.5% (47/149) while 68.5% (102/ 149) underwent laparoscopic cryoablation. The mean tumor size was 2.6 cm [range 0.9–6 cm], median number of treated lesions was 1 [range 1–3]. A median number of 3 cryoablation needles [range 1–6] were used for the procedure and an intraoperative kidney biopsy was performed in 94.6% (141/149) of the patients. Pathology revealed 68.5% malignant, 16.8% benign, 14.8% indeterminate results. The median number of freeze/thaw cycles was 2 with mean duration of 9.4 min for the first and 8.5 min for the second freeze cycle. The median follow-up for percutaneous and laparoscopic cryoablation patients was 65.5 month and 70.5 month, with a recurrence rate of 12.1% and 16.4%, respectively. The mean time to recurrence was 15.8 and 15.2 month, respectively. Eight patients died of cancer, 24 had locoregional recurrence and 2 patients had distant metastasis. 5 year overall, disease specific and disease free survival rates were 87.7%, 96.1% and 86.8%.
Conclusions: In this largest multi-institutional series of laparoscopic and percutaneous renal cryoablation for SRM we demonstrate excellent oncological outcomes in selected patients with a disease free survival rate of 86.8%.
Source of Funding: None
Click HERE to read session highlights written by Zhamshid Okhunov, MD of the University of California - Irvine
Presented by: Lusch A,a Bucur P,a Okhunov Z,a Kavoussi LR,c Badani K,d Derweesh I,b Liss M,b Wyler S,e Laguna MP,f De La Rosette JJ,f Bawari K,f Tsivian M,g Polascik TJ,g Klatte T,h Klingler HC,h Pattaras J,i Osann K,a and Landman Ja at the 31st World Congress of Endourology (WCE) - October 22 - 26, 2013 - New Orleans, LA USA
Department of Urology, University of California, Irvine, USA;a Department of Urology, University of California, San Diego, USA;b Arthur Smith Institute of Urology, North Shore-Long Island Jewish Hospital, New Hyde Park;c Department of Urology, Columbia University Medical Center, New York, USA;d Department of Urology, University Hospital Basel, Basel, Switzerland;e Department of Urology, Academic Medical Center , Amsterdam, The Netherlands;f Division of Urology, Department of Surgery, Duke University Medical Center, Duke Cancer Institute, Durham, USA;g Department of Urology, Medical University of Vienna, Vienna, Austria;h Department of Urology, Emory University School of Medicine, Atlanta, USAi
