Minimally Invasive Partial Nephrectomy Versus Laparoscopic Cryoablation for Patients Newly Diagnosed with a Single Small Renal Mass

Nicola Fossati; Alessandro Larcher; Giulio M Gadda; Daniel D Sjoberg; Francesco A Mistretta; Paolo Dell'Oglio; Giuliana Lista; Cristina Carenzi; Giovanni Lughezzani; Massimo Lazzeri; Francesco Montorsi; Andrew J Vickers; Giorgio Guazzoni; Nicolò Maria Buffi

doi:10.1016/j.euf.2015.02.002

Minimally Invasive Partial Nephrectomy Versus Laparoscopic Cryoablation for Patients Newly Diagnosed with a Single Small Renal Mass

Eur Urol Focus. 2015 Aug;1(1):66-72. doi: 10.1016/j.euf.2015.02.002. Epub 2015 May 20.

Affiliations

¹ Division of Oncology / Unit of Urology, URI, IRCCS Ospedale San Raffaele - Ville Turro, Milan, Italy; Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. Electronic address: nicola.fossati@gmail.com.
² Division of Oncology / Unit of Urology, URI, IRCCS Ospedale San Raffaele - Ville Turro, Milan, Italy.
³ Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
⁴ Department of Urology, Humanitas Clinical and Research Center, Humanitas University, Milan - Italy.

PMID: 28723359
DOI: 10.1016/j.euf.2015.02.002

Abstract

Background: Minimally invasive partial nephrectomy (MIPN) and laparoscopic renal cryoablation (LRC) are two treatment options increasingly used for small renal masses.

Objective: To compare perioperative, oncologic, and functional outcomes after MIPN and LRC.

Design, setting, and participants: We included 372 consecutive patients newly diagnosed with a single small renal mass and treated with either MIPN or LRC at a single institution.

Intervention: MIPN and LRC.

Outcome measurements and statistical analysis: Regression models were used to evaluate the impact of surgical treatment (MIPN vs LRC) on perioperative, oncologic, and functional outcomes.

Results and limitations: Overall, 206 patients (55%) underwent MIPN and 166 (45%) were treated with LRC. In multivariate analysis, the rate of postoperative complications was significantly lower in the MIPN compared to the LRC group (20% vs 28%; adjusted difference -11%; p=0.02) after adjusting for age at surgery, American Society of Anesthesiologists score (1 vs 2 vs 3), and tumor size. The median follow-up was similar in the two groups (43 and 39 mo for MIPN and LRC, respectively). In univariate Cox regression analysis, treatment type was not significantly associated with disease-free survival (hazard ratio 1.06, 95% confidence interval [CI] 0.45-2.52; p=0.9). The disease-free survival rate at 5 yr was 92% in MIPN and 93% in LRC patients. In multivariate linear regression analysis, LRC was significantly associated with a higher estimated glomerular filtration rate (eGFR) at 6 mo compared to MIPN (coefficient 4.68, 95% CI 0.06-9.30; p=0.047) after adjusting for age at surgery, tumor size, and preoperative eGFR. There was no significant association between surgical treatment and postoperative eGFR at 3 yr after surgery (coefficient -2.36, 95% CI -7.55 to 2.83; p=0.4). Limitations include the retrospective study design and selection bias.

Conclusions: MIPN and LRC provided similar cancer control and comparable renal function at intermediate-term follow-up. Both surgical techniques emerged as viable treatment options for patient newly diagnosed with a single small renal mass. Further multi-institutional studies with longer follow-up and nephrometry scores are needed to corroborate our findings.

Patient summary: In patients newly diagnosed with a single small renal mass, minimally invasive partial nephrectomy and laparoscopic renal cryoablation provided similar cancer control and comparable renal function at intermediate-term follow-up.

Keywords: Cryosurgery; Minimally invasive surgery; Partial nephrectomy; Small renal mass.