Korean J Urol.  2010 Mar;51(3):171-177.

The Impact of Renal Tumor Size on the Efficacy of Laparoscopic Renal Cryoablation

• Ham BK
• Kang SG
• Choi H
• Ko YH
• Kang SH
• Cheon J

Abstract

PURPOSE
We evaluated the impact of renal tumor size on the oncologic and surgical efficacy of laparoscopic renal cryosurgery (LRC) according to our intermediate-term experience in Korea. MATERIALS AND METHODS: From June 2005 to October 2008, we enrolled 37 patients who underwent LRC for 40 renal tumors. Patients were stratified into four groups according to renal tumor size. Patients who presented with a maximum tumor diameter (MTD) of at least 1 cm but less than 2 cm were assigned to Group 1, those with an MTD equal to or greater than 2 but less than 3 cm were assigned to Group 2, those with an MTD equal to or greater than 3 but less than 4 cm were assigned to Group 3, and those with an MTD equal to or greater than 4 cm were assigned to Group 4. Oncologic and clinical outcomes in each group were compared. RESULTS: The four groups showed no statistically significant differences in preoperative variables, including age, sex, body mass index, American Society of Anesthesiologists scores, baseline renal function and hemoglobin, and length of hospital stay. Regarding surgical aspects, however, operation time, estimated blood loss, and postoperative complications were significantly increased in patients with larger tumors. Three patients in Group 3 required postoperative transfusions, and 1 patient in Group 4 required conversion to open renal cryosurgery. During the mean follow-up period of 31.6 months, radiologic evidence of tumor recurrence was found in only 2 patients in Group 4. CONCLUSIONS: In this series, LRC for renal tumors smaller than 3 cm was conducted safely without radiologic evidence of tumor recurrence during intermediate-term follow-up. For tumors larger than 3 cm, however, the transfusion rate increased, and for renal tumors larger than 4 cm, the tumor recurrence rate increased significantly.

Keyword

Cryosurgery; Laparoscopy; Renal cell carcinoma

MeSH Terms

Body Mass Index
Carcinoma, Renal Cell
Cryosurgery
Follow-Up Studies
Hemoglobins
Humans
Korea
Laparoscopy
Length of Stay
Postoperative Complications
Recurrence
Hemoglobins

Figure

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  FIG. 1 (A) A 65-year-old female patient with a renal mass in the left solitary kidney that measured 7.5 cm. The arrow shows an ill-defined rim enhancement near the mass lesion at 1 month after left laparoscopic renal cryoablation by abdominal MRI scan (T1 images). (B) A 34-year-old female patient with a completely endophytic renal mass in the left kidney that measured 4.0 cm. The arrow shows a local recurrence near the mass lesion at 3 months after left laparoscopic renal cryoablation by abdominal pelvic CT scan.

• 

  FIG. 2 (A) A 63-year-old female patient with a 3.9 cm left renal cell carcinoma (RCC). The figure shows the decreased size of the treated RCC in the left kidney without a definite viable portion at 3 months and 24 months after left laparoscopic renal cryoablation by abdominal CT scan. (B) A 55-year-old male patient with a right RCC that measured 3.1 cm. The figure shows the decreased size of the treated RCC in the right kidney, without a definite viable portion at 3 months and 24 months after right laparoscopic renal cryoablation by abdominal CT scan.

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