NEW YORK (Reuters Health) – While partial nephrectomy remains the gold standard for treatment of small renal masses, laparoscopic cryoablation is a good option for selected patients, an Austrian team reports.

“Balancing cancer control and patient morbidity will be crucial for counseling the patient,” add Dr. Tobias Klatte, at the Medical University of Vienna, and colleagues in their report in European Urology online May 17.

The team notes that up to 90% of small renal masses are malignant renal cell carcinomas requiring treatment, and that “importantly” the highest incidence is in elderly patients who usually have several comorbidities. While the standard of care has been partial nephrectomy, it has a complication rate of about 20%.

“Laparoscopic cryoablation could be regarded as an alternative to surgical excision in selected patients, if perioperative complication rates and oncologic results are comparable,” they point out.

To look into this possibility, the authors compiled published data on a total of 6785 small renal masses occurring in 6642 patients. Partial nephrectomy was used to treat 5379 of the tumors while laparoscopic cryoablation was used on 1406.

The overall rate of local tumor progression in cases of proven renal cell carcinoma was 2.9%. However, the rate was 1.9% after partial nephrectomy compared to 8.5% after cryoablation, according to the report.

On the other hand, the incidence of perioperative complications was 23.5% with partial nephrectomy versus 17.0% with laparoscopic cryoablation – a statistically significant difference (p<0.001).

After propensity score adjustment, partial nephrectomy was a significant risk factor of major complications (risk ratio 7.25; p = 0.022) but not of minor complications (RR 0.71; p = 0.748), the researchers found. However, noting the effect of selection bias, they say that only limited conclusions can be made about differences in complications between the two procedures.

“This cumulative analysis shows that both partial nephrectomy and laparoscopic cryoablation are viable options for the management of patients with small renal masses. Compared with partial nephrectomy, laparoscopic cryoablation results in a higher risk of local tumor progression but a lower risk of perioperative complications,” Dr. Klatte and colleagues say in summarizing their results.

“Partial nephrectomy is therefore the gold standard for small renal masses,” they conclude, “but laparoscopic cryoablation may be indicated in selected patients with significant comorbidity.”

Reference:
Laparoscopic Cryoablation Versus Partial Nephrectomy for the Treatment of Small Renal Masses: Systematic Review and Cumulative Analysis of Observational Studies
Eur Urol 2011.