Laparoscopic Renal Cryoablation (LRC) Of Small Renal Masses

Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology
Article Date: 06 Apr 2008 - 0:00 PST

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UroToday.com - A group from Milan, Italy prospectively analyzed the outcome of patients with kidney masses treated with laparoscopic cryoablation over a 7-year period. Beginning in September 2000, 104 patients (mean age 61.6 years; 78 male and 26 female) underwent LRC for renal masses. The mean lesion diameter was 2.2cm. The procedure was performed transperitoneally in 60 cases and in 44 patients it was done retroperitoneoscopically, based upon the tumor position or potential difficulties due to previous abdominal surgery. Fifty-six patients (54%) had concomitant comorbidities.

The intra-operative mean diameter of the ice ball was 4.93cm. All the procedures were successfully completed laparoscopically, except 3 cases that were converted to open surgery, two of them due to bleeding from the site of the cryoprobe insertion (one of them requiring radical nephrectomy). Mean surgical time was 202.6min (range 90-320 min) and mean intra-operative blood loss was 211.6 cc (range 10-3.200 cc). Pathological evaluation of the intra-operative needle biopsies documented renal cell carcinoma in 64 cases, 23 oncocytomas, 6 angiomyolipomas, 1 case of Xantogranulomatous pyelonephritis and 10 cases "undefined" disease. Post-operative stay was 4.7 days (range 2-13). Postoperative complications were always treated conservatively and included 7 cases of transient fever, 2 cases of small peri-renal hematomas, 1 case of pulmonary edema, 9 patients with significant blood loss and 1 case of gross hematuria. Delayed complication included 1 case of UPJ obstruction requiring open pyeloplasty 8 months after surgery and open nephrectomy one year after surgery due to suspected recurrence of the disease. Six patients died during the follow-up, 5 due to previous illness and 1 patient due to worsening cirrhosis one month after surgery. No patients died secondary to renal cancer.

MRI scans on postoperative day one revealed a mean lesion of 4.91cm. Progressive reduction in size of the ablated lesion was visible in all patients with only a renal scar visible after 24 months of follow-up. This remained constant over time with 36 patients being followed up for 5 years and 11 patients for 7. In the question period, Dr. Jewett (Toronto) pointed out that 40% of the patients with benign lesions had unnecessary treatment and perhaps the biopsies should be performed a few weeks prior to the intended procedure.

Presented by: A. Cestari, MD, et al, at the European Association of Urology - 23rd Annual EAU Congress - March 26 - 29, 2008 - Milan, Italy

Reported by UroToday.com Contributing Editor, Christopher P. Evans, MD

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