Journal Article Page
European UrologyVolume 53, issue 6, pages 1101-1322, June 2008
Laparoscopic Partial Nephrectomy versus Laparoscopic Cryoablation for Multiple Ipsilateral Renal Tumors
Accepted 29 February 2008, Published online 18 March 2008, pages 1210 - 1218
Management of multiple ipsilateral renal tumors is a dilemma in clinical practice. The effects of minimally invasive nephron-sparing procedures in this group of patients have not been assessed.
To evaluate the technical feasibility and outcomes of laparoscopic partial nephrectomy (LPN) and laparoscopic cryoablation (LCA) for multiple ipsilateral renal tumors.
Design, Setting, and Participants
Between September 1999 and December 2006, 27 patients were treated with minimally invasive nephron sparing surgery (LPN or LCA) for synchronous multiple ipsilateral renal tumors in a single operating session at our institution. Fourteen patients with 28 tumors underwent LPN, and 13 patients with 31 tumors underwent LCA as the sole treatment modality.
Medical records were retrospectively reviewed and data were collected.
Demographic, intraoperative, postoperative, and intermediate-term follow-up data were compared between the two groups.
Results and Limitations
Patients in the LPN group had fewer tumors (2 vs. 2.4, p = 0.04) and larger dominant tumor size (3.6 vs. 2.5 cm, p = 0.005) in the affected kidney and lower preoperative serum creatinine levels (1 vs. 1.4 mg/dl, p = 0.02). Compared to the LCA group, patients in the LPN group had greater estimated blood loss (200 vs. 125 ml, p = 0.02) and longer hospital stays (90 vs. 52.3 h, p = 0.02). There were no open conversions, and no kidneys were lost. Complication rate, renal functional outcomes, and intermediate-term cancer-specific survival rates were similar between the two groups.
Both LPN and LCA are viable options for patients with multiple ipsilateral renal tumors in select patients. Renal functional outcomes, complication rates, and intermediate-term survival rates are comparable between the two groups in this small series.
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