NEW YORK (Reuters Health) – Laparoscopic partial nephrectomy (LPN) and laparoscopic cryoablation (LCA) are viable nephron-sparing options for patients with a small tumor in a solitary kidney, researchers report in a September 2nd on-line paper in BJU International.

Both methods, Dr. Georges-Pascal Haber told Reuters Health by email, “are effective and safe treatments for tumors in patients with only one functioning kidney.”

“In expert hands,” he added, “laparoscopic partial nephrectomy is the preferred treatment because of better cancer control. However, in patients who already have poor kidney function, cryoablation is less likely to cause a need for dialysis.”

Dr. Haber of the Cleveland Clinic Foundation, Ohio and colleagues came to this conclusion after retrospectively analyzing data on 48 patients who underwent LPN and 30 who had LCA over a 10-year period. None were candidates for percutaneous cryoablation due to the anterior location of the tumor and the proximity to bowel.

Tumors were larger in the LPN group (3.2 cm versus 2.6 cm) and that approach was associated with more blood loss (391 mL versus 162 mL). There was also a trend towards more postoperative complications (22.9% versus 6.7%).

At 3 months, postoperative eGFR fell by 14.5% in the LPN group and 7.3% in the LCA patients. Temporary dialysis was needed in 3 of the LPN patients but none of the LCA patients

After a median of up to 5 years of follow-up in these groups, 4 LCA patients showed local recurrence. This was not true of any of the LPN patients.

Overall survival, at 3 years was the same in both groups (93%) and was not significantly different at 5 years. Cancer-specific survival in the LPN and LCA groups was 100% versus 93% at 3 years and 100% versus 92% at 5 years.

Altogether the investigators conclude that “LCA is technically easier and has superior functional outcomes. However, LPN has superior oncological outcomes.” Thus, “Longer data are needed to better define the role of LPN and LCA in this challenging patient population.”

Reference:

Tumor in Solitary Kidney: Laparoscopic Partial Nephrectomy vs Laparoscopic Cryoablation

BJU Int 2011.