Objective
To analyze outcomes and complications of percutaneous (PRC) and laparoscopic renal
cryoablation (LRC) using the radius, endophytic, nearness to collecting system, anterior/posterior,
and location (RENAL) nephrometry system.
Methods
Retrospective multicenter analysis of 154 consecutive patients who underwent either
ultrasound-guided LRC (n = 88) or computed tomography (CT)-guided PRC (n = 66) from
March 2003 to December 2011. RENAL score and demographics were compared to postoperative
complications (Clavien). Multivariable analysis was carried out for factors associated
with development of postprocedure complications.
Results
Mean age was 68 years (94 men/60 women). Median follow-up was 34 months (range 23.6-45.6
months). Mean tumor size was 2.6 ± 1 cm. Mean RENAL score was 5.2 ± 1.4. Differences
in (A)nterior/posterior component and (H)ilar domain of the RENAL scores were noted,
with PRC favoring posterior tumors and hilar lesions compared to LRC (P < .001 and P = .044, respectively). There were 14.9% complications, all of which were low-grade
(Clavien 1,2). There were no differences in complications between LRC and PRC (15.9%
vs 13.6%, P = .82). Most common complication type was hemorrhagic in 9 of 154 patients (5.8%);
significant increase in the hemorrhagic complication rate was noted for patients with
“N” (“nearness”) component score of 2 or 3 (5/36, or 13.9%), compared to patients
with “N” score of 1 (4/115 or 3.5%, P = .033). multivariable analysis demonstrated that increasing RENAL score was associated
with postprocedure complications (odds ratio [OR] = 1.37, P = .025). When separated into individual domains, multivariable analysis revealed
that “N” score 3 was significantly associated with postoperative complications (OR
16.15, P = .027).
Conclusion
Increasing RENAL score was associated development of postprocedure complications after
renal cryotherapy. Further investigation is requisite to elucidate the role of RENAL
nephrometry score in risk stratification prior to renal cryotherapy.
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References
- Treatment trends for stage I renal cell carcinoma.J Urol. 2011; 186: 394-399
- Rising incidence of small renal masses: a need to reassess treatment effect.J Natl Cancer Inst. 2006; 98: 1331-1334
- Excise, ablate or observe: the small renal mass dilemma–a meta-analysis and review.J Urol. 2008; 179 ([Discussion: 1233-1234]): 1227-1233
- Guideline for management of the clinical T1 renal mass.J Urol. 2009; 182: 1271-1279
- Single center comparison of laparoscopic cryoablation and CT-guided percutaneous cryoablation for renal tumors.J Endourol. 2008; 22: 2461-2467
- RENAL nephrometry score is associated with operative approach for partial nephrectomy and urine leak.Urology. 2012; 80: 151-156
- Second prize: recurrence rates after percutaneous and laparoscopic renal cryoablation of small renal masses: does the approach make a difference?.J Endourol. 2011; 25: 371-375
- Laparoscopic and percutaneous cryotherapy for renal neoplasms.Panminerva Med. 2010; 52: 331-338
- The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth.J Urol. 2009; 182: 844-853
- Cryotherapy: clinical end points and their experimental foundations.Urology. 2006; 68: 38-44
- Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.Ann Surg. 2004; 240: 205-213
- Predictors of locally advanced and metastatic disease in patients with small renal masses.BJU Int. 2012; 109: 1463-1467
- Kidney tumor location measurement using the C index method.J Urol. 2010; 183: 1708-1713
- Utility of the R.E.N.A.L. nephrometry scoring system in objectifying treatment decision-making of the enhancing renal mass.Urology. 2011; 78: 1089-1094
- Preoperative aspects and dimensions used for an anatomical (PADUA) classification of renal tumours in patients who are candidates for nephron-sparing surgery.Eur Urol. 2009; 56: 786-793
- Evolving practice patterns for the management of small renal masses in the USA.BJU Int. 2012; 110: 1156-1161
- Prediction of perioperative outcomes following minimally invasive partial nephrectomy: role of the R.E.N.A.L nephrometry score.World J Urol. 2012; ([Epub ahead of print])
- Complications of renal cryoablation: a single center experience.J Urol. 2010; 184: 42-47
- Percutaneous and laparoscopic cryoablation of small renal masses.J Urol. 2008; 180 ([Discussion: 498]): 492-498
- Cryosurgical ablation of renal cell carcinoma.Cancer Control. 2007; 14: 211-217
- Comparison of postoperative pain, convalescence, and patient satisfaction after laparoscopic and percutaneous ablation of small renal masses.J Endourol. 2008; 22: 963-967
- Comparison of percutaneous and laparoscopic cryoablation for the treatment of solid renal masses.AJR Am J Roentgenol. 2008; 191: 1159-1168
- Complications of laparoscopic and percutaneous renal cryoablation in a single tertiary referral center.Eur Urol. 2010; 58: 142-147
- Perioperative morbidity of laparoscopic cryoablation of small renal masses with ultrathin probes: a European multicentre experience.Eur Urol. 2009; 56: 355-361
- Comparison of percutaneous and laparoscopic renal cryoablation for small (<3.0 cm) renal masses.J Endourol. 2010; 24: 1097-1100
- Single-center comparison of complications in laparoscopic and percutaneous radiofrequency ablation with ultrasound guidance for renal tumors.Urology. 2012; 80: 119-124
- Complications following 573 percutaneous renal radiofrequency and cryoablation procedures.J Vasc Interv Radiol. 2012; 23: 48-54
- Assessment of risk factors for complications of laparoscopic partial nephrectomy.Eur Urol. 2008; 53: 590-596
- Clinical sequelae of radiographic iceball involvement of collecting system during computed tomography-guided percutaneous renal tumor cryoablation.Urology. 2006; 67: 918-922
- Percutaneous cryoablation of renal lesions with radiographic ice ball involvement of the renal sinus: analysis of hemorrhagic and collecting system complications.AJR Am J Roentgenol. 2011; 196: 935-939
Article info
Publication history
Published online: February 21, 2013
Accepted:
November 27,
2012
Received:
July 18,
2012
Footnotes
The views and opinions of, and endorsements by the author(s) do not reflect those of the United States Navy or the Department of Defense.
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
