Study Type – Therapy (cohort)
Level of Evidence 2b
What’s known on the subject? and What does the study add?
Tumour in a solitary functioning kidney represents an absolute indication for nephron-sparing surgery whenever technically feasible. We report the longest follow-up data comparing laparoscopic partial nephrectomy and laparoscopic cryoablation in patients with solitary kidney with oncological follow-up to five years.
• We compare perioperative, functional and intermediate-term oncological outcomes of laparoscopic partial nephrectomy (LPN) vs laparoscopic cryoablation (LCA) for small renal tumour in patients with a solitary kidney.
• A treatment algorithm is also proposed.
PATIENT AND METHODS
• Over a 10-year period (02/1998-09/2008), 78 patients with a small tumour in a functionally solitary kidney underwent LPN (n= 48) or LCA (n= 30).
• Baseline, perioperative, and follow-up data were collected prospectively and analyzed retrospectively.
• Demographic data were similar between the LPN and LCA groups. Tumours were somewhat larger (3.2 vs 2.6 cm) in the LPN group. LPN was associated with greater blood loss (391 vs 162 mL; P= 0.003), and trended towards more post-operative complications (22.9% vs 6.7%; P= 0.07).
• By 3 months post-operative, eGFR decreased by 14.5% and 7.3% after LPN and LCA, respectively (P= 0.02). Post-operative temporary dialysis was required after 3 LPN (6.2% vs 0%, P= 0.16).
• Median follow-up time for LPN and LCA was 42.7 and 60.2 months, respectively.
• Local recurrence was detected in 4 (13.3%) LCA patients only (P= 0.02).
• Overall survival was comparable between LPN and LCA at 3 and 5 years, respectively (P= 0.74). The LPN group had superior cancer-specific and recurrence-free survival at 3 and 5 years compared to the LCA group (P < 0.05, for all comparisons).
• Given adequate technical expertise, both LPN and LCA are viable nephron-sparing options for patients with tumour in a solitary kidney.
• Although LCA is technically easier and has superior functional outcomes, oncologic outcomes are superior after LPN.