EUF Vol. 1 No. 1

66 96

Priority Focus – Kidney Cancer
Editorial by Jed-Sian Cheng and Michael L. Blute on pp. 73–74 of this issue
Minimally Invasive Partial Nephrectomy Versus Laparoscopic
Cryoablation for Patients Newly Diagnosed with a Single Small
Renal Mass
Nicola Fossati Alessandro Larcher Giulio M. Gadda Daniel D. Sjoberg
Francesco A. Mistretta Paolo Dell’Oglio Giuliana Lista Cristina Carenzi
Giovanni Lughezzani Massimo Lazzeri Francesco Montorsi Andrew J. Vickers
Giorgio Guazzoni Nicolo` Maria Buffi
a Division of Oncology / Unit of Urology, URI, IRCCS Ospedale San Raffaele – Ville Turro, Milan,Italy; bDepartment of Epidemiology and Biostatistics, Memorial
Sloan-Kettering Cancer Center, New York, NY, USA; c Department of Urology, Humanitas Clinical and Research Center, Humanitas University, Milan – Italy
available at
journal homepage:
Article info
Article history:
Accepted February 4, 2015
Associate Editor:
Tobias Klatte
Keywords:
Small renal mass
Minimally invasive surgery
Partial nephrectomy
Cryosurgery
Abstract
Background: Minimally invasive partial nephrectomy (MIPN) and laparoscopic renal cryoa-
blation (LRC) are two treatment options increasingly used for small renal masses.
Objective: To compare perioperative, oncologic, and functional outcomes after MIPN and LRC.
Design, setting, and participants: We included 372 consecutive patients newly diagnosed
with a single small renal mass and treated with either MIPN or LRC at a single institution.
Intervention: MIPN and LRC.
Outcome measurements and statistical analysis: Regressionmodels were used to evaluate the
impact of surgical treatment (MIPNvs LRC) onperioperative, oncologic, and functional outcomes.
Results and limitations: Overall, 206 patients (55%) underwent MIPN and 166 (45%) were
treated with LRC. In multivariate analysis, the rate of postoperative complications was
significantly lower in the MIPN compared to the LRC group (20% vs 28%; adjusted difference
–11%; p = 0.02) after adjusting for age at surgery, American Society of Anesthesiologists score
(1 vs 2 vs 3), and tumor size. The median follow-up was similar in the two groups (43 and
39 mo for MIPN and LRC, respectively). In univariate Cox regression analysis, treatment type
was not significantly associated with disease-free survival (hazard ratio 1.06, 95% confidence
interval [CI] 0.45–2.52; p = 0.9). The disease-free survival rate at 5 yr was 92% in MIPN and 93%
in LRC patients. In multivariate linear regression analysis, LRC was significantly associated
with a higher estimated glomerular filtration rate (eGFR) at 6 mo compared to MIPN
(coefficient 4.68, 95% CI 0.06–9.30; p = 0.047) after adjusting for age at surgery, tumor size,
and preoperative eGFR. There was no significant association between surgical treatment and
postoperative eGFR at 3 yr after surgery (coefficient –2.36, 95% CI –7.55 to 2.83; p = 0.4).
Limitations include the retrospective study design and selection bias.
Conclusions: MIPN and LRC provided similar cancer control and comparable renal function at
intermediate-term follow-up. Both surgical techniques emerged as viable treatment options
for patient newly diagnosed with a single small renal mass. Further multi-institutional studies
with longer follow-up and nephrometry scores are needed to corroborate our findings.
Patient summary: In patients newly diagnosed with a single small renal mass, minimally
invasive partial nephrectomy and laparoscopic renal cryoablation provided similar cancer
control and comparable renal function at intermediate-term follow-up.
# 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.
* Corresponding author. Division of Oncology / Unit of Urology, IRCCS Ospedale San Raffaele – Ville
Turro, Vita-Salute San Raffaele University, Via Stamira d’Ancona, 20, 20127 Milan, Italy.
Tel. +39 02 26433357; Fax: +39 02 26433442.
E-mail address: (N. Fossati).
2405-4569/# 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.