Minimally Invasive Nephron Sparing Management Of Renal Tumors In Solitary Kidneys
ORLANDO, FL (UroToday.com) - Among 101 patients with a renal mass in a solitary kidney, the authors employed three forms of less invasive surgery: laparoscopic partial nephrectomy (36), cryoablation (either laparoscopic or percutaneous) (36), and percutaneous radiofrequency ablation (29).
The cancer specific survival among these patients at only 2 years, was 100%, 89%, and 84% respectively; however, the disease free survival rate was 100%, 70%, and 33%, respectively! Creatinine clearance decreases were 18%, 3%, and 7%, respectively. Given the less than optimal results with radiofrequency ablation, the authors currently prefer to use cryoablation for percutaneous needle ablation therapy. Of note, two of the patients in the laparoscopic group went on to nephrectomy and hemodialysis: one due to bleeding and one for a positive margin. Overall, for tumors > 4 cm, a laparoscopic partial nephrectomy is done whereas for tumors < 4 cm. both laparoscopic and needle ablative options are open dependent upon the location and nature of the renal mass (e.g. posterior lesions are favored for needle ablation).
The safety and effectiveness of cryoablation, especially via a percutaneous approach, continues to grow with regard to the management of small renal masses; today at my university, percutaneous cryoablation has become the most commonly used modality for dealing with small renal masses.
Presented by Burak Turna, MD, et al., at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.
Reported by UroToday.com Medical Editor Ralph V. Clayman, MD
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