INTRODUCTION & OBJECTIVES: Laparoscopic renal cryoablation [LRC] is an effective minimally invasive treatment option for small renalmasses [SRMs], but evidences regarding long-term oncologic safety are still lacking. The aim of this study is to evaluate the long-termoncological outcomes of LCR in patients with at least one SRM.MATERIAL & METHODS: The study design is an observational, retrospective analysis of prospectively collected data of 189 consecutivepatients who underwent LRC between 2000 and 2013. Overall, 214 cT1a contrast enhanced SRMs were diagnosed on CT or MRI scan andsubsequently treated with LRC at our institution. Surgery consisted of transperitoneal or retroperitoneal access to the renal cavity, kidneymobilization, laparoscopic ultrasound evaluation, ultrasound-guided biopsy of the lesion, puncture of the SRM with the cryoprobes anddouble freeze-thaw cycle extending the ice ball approximately 1 cm beyond the tumor edge. Patients were evaluated on post-operative day1 with MRI to assess the treatment efficacy: residual disease was defined as persistent enhancing tissue in the treated area. Follow-up wasdetermined using serial MRI at 1, 6, 12, 24, 36, 48, 60, 72 and 120 months. Local recurrence after LRC was defined as the presence of anenhancing nodule in the treated area increasing in size. The outcome of the study was to evaluate the 5 years disease free survival, cancerspecific survival and overall survival.RESULTS: Mean follow up was 55.6 months (range 1-156). Mean patient age was 63.42 (range 25 - 88). Median tumour size was 21 mm(range 7 - 40). The mean ice-ball diameter after surgery was 44.8 mm (range 18 - 80), and it decreased over time: MRI showed a mean iceballdiameter of 35.0, 23.3, 18.5, 13.5, 11.7, 9.5, 6.4, 5.8 and 2.4 mm at 1, 6, 12, 24, 36, 48, 60, 72 and 120 months, respectively (p<0.001).Histologic examination revealed 135 renal cell carcinoma, 57 benign lesions and 22 non-diagnostic tissues. Overall 10 patients patientsdeveloped a metachronous renal neoplasm located in a different site than the cryoablated area. Among patients diagnosed with a renalmalignancy, only one showed residual disease after surgery and was effectively treated with a 2nd look LRC, while 4 patients developed alocal recurrence. Median time to local recurrence was 18 months (range 6 - 48). The treatment of the recurrence was radical nephrectomy in2 cases, partial nephrectomy in one case and radio-frequency ablation in one case. Five-years disease free survival, cancer specificsurvival and overall survival were 96.91%, 100% and 95.1%, respectively.CONCLUSIONS: Laparoscopic renal cryoablation ensures optimal cancer control outcomes at long term follow-up. These results should betaken into account in patients with small renal masses.
|Titolo:||LONG-TERM ONCOLOGIC OUTCOMES OF LAPAROSCOPIC RENAL CRYOABLATION: 10 YEARS RESULTS FROM A SINGLE INSTITUTION|
|Data di pubblicazione:||2014|
|Appare nelle tipologie:||1.5 Abstract in rivista|