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Laparoscopic Renal Cryoablation For Tumors Less Than 3.5 CM
T. J. Polascik, V. Mouraviev, I. Nosnik, J. M. Mayes; Duke Medical University Center, Durham, NC.
Background: Laparoscopic renal cryoablation for small renal tumors is a minimally invasive therapy that is gaining clinical acceptance. We present our short term outcomes and complications for patients undergoing laparoscopic renal cryoablation. Methods: Between September 2000 and September 2006, 31 patients underwent primary laparoscopic cryosurgical procedures (33) for an organ-confined renal tumor(s). In one case, cryosurgery was done sequentially on both kidneys. All patients had been carefully selected based on the following criteria: tumor size < 3.5 cm, the absence of local and systemic spread on MRI or CT, and the ability to tolerate general anesthesia. A pure laparoscopic approach was employed using third generation cryotechnology (Oncura Inc., Plymouth Meeting, PA). Patients were followed by serial CT or MRI scan, creatinine level and physical examination at least every 6 months after cryotherapy. Results: The median patient age was 66.3 years (range: 44-79) and the median follow-up was 20.9 months. The median tumor size was 2.0 cm (range: 1-3.5 cm). Only 1 patient required a blood transfusion and 1 patient developed a transient ileus. The median length of stay was 2.0 days (range: 0-9 days). The median change in creatinine was 0.1 mg/dl (range: -0.4 to1.9). One patient was converted to open surgery. No evidence of recurrence or progression was found in all patients, and overall survival rate was 100%. Conclusions: Laparoscopic renal cryoablation of the small renal tumor is a safe procedure with minimal complications. Although there were no recurrences with short term follow-up, further long term study is needed to verify its efficacy.
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