Laparoscopic Cryoablation Of Small Renal Tumors – Does Anatomical Tumor Complexity Affect Treatment Outcome?

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Background: Renal cryoablation is a valid treatment option for localized pT1a renal tumors and has been the modality of choice at Aarhus University Hospital since 2005. Anatomical tumor classification systems such as PADUA and RENAL scores were initially introduced as tools to evaluate complication risk in relation to nephron sparing surgery, but they may also be useful when planning cryoablation. Aim: The aim of the present study was to investigate whether patients with an anatomical complex tumor, represented by a high PADUA-score (≥10), carried a higher risk of residual unablated tumor compared to patients with a less anatomical complex tumor when treated with laparoscopic cryoablation. Material and methods: A retrospective review of Aarhus Cryoablation Register identified 120 patients with a single biopsy-verified pT1a renal tumor, treated with primary laparoscopic cryoablation between August 2005 and December 2013. Patients were followed-up postoperatively with contrast-CT for up to 5 years or until a residual unablated tumor was diagnosed. Results: Mean patient age: 63 years (95%CI 61;65). Mean BMI: 27 kg/m2 (95%CI 26;28). Mean ASA-score: 2.1 (95%CI 2;2.2). Mean ECOC performance status: 1.2 (95%CI 1.0;1.3). Mean tumor size: 27 mm (95%CI 26;29). Mean follow-up time: 24 months (95%CI 20;27). A total of 16 patients (13%) were previously diagnosed with renal cancer and the majority of these patients had previously undergone nephrectomy. PADUA-score was found to be low or moderate (<10) in 93 patients (77.5%) and high (≥10) in 24 patients (20%). In 3 patients (2.5%) the PADUA-score could not be obtained. Residual unablated tumor was diagnosed in 8/93 patients (8.6%) with a low-moderate PADUA-scoring tumor compared to 6/24 patients (25%) with a high PADUA-scoring tumor. This relative risk of 2.9 (95%CI 1.1;7.6) was statistically significant (p=0.03). The mean follow-up time from treatment to diagnosis of treatment failure was 13 months (95%CI 8;18), which was not significantly different between the two groups. Conclusion: Patients with an anatomical complex tumor, represented by a PADUA-score ≥10 carries a significantly higher risk of residual unablated tumor compared to patients with a less anatomical complex tumor, when treated with laparoscopic cryoablation.
Original languageEnglish
Publication year2015
Publication statusPublished - 2015
EventEAU 2015 - Madrid, Spain
Duration: 21 Mar 2014 → …

Conference

ConferenceEAU 2015
LocationMadrid
CountrySpain
Period21/03/2014 → …

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