Complications of laparoscopic and percutaneous renal cryoablation in a single tertiary referral center.
BACKGROUND: Laparoscopic cryoablation (LCA) and percutaneous cryoablation (PCA) of small renal masses have gained popularity, but only limited data exist on the complication rates. OBJECTIVES: In this study, we report on postoperative complications associated with LCA and PCA in a single tertiary center experience. DESIGN, SETTING, AND PARTICIPANTS: We conducted a retrospective review of electronic medical records for patients undergoing LCA or PCA between 2001 and 2008 at our institution. INTERVENTIONS: All patients underwent LCA or PCA. MEASUREMENTS: Demographics, radiographic variables, and complication rates were compared between the two groups. Complications were classified according to the modified Clavien system. RESULTS AND LIMITATIONS: Of a total of 195 patients included in this study, 72 underwent LCA and 123 underwent PCA. There were no differences in demographics between the groups. We observed complications in 10 LCA procedures (13.9%) and 26 PCA procedures (21.1%) (p=0.253). The distribution of the complications differed significantly between the groups with mild complications (grades 1 and 2) more common in the PCA group (20.3% vs 5.6%, respectively; p=0.001), whereas severe events (grades 3 and 4) were more frequent in the LCA group (8.3% vs 0.8%, respectively; p=0.011). On multivariate analysis, age and body mass index were inversely associated with complications, whereas female gender, multiple tumors, and preexisting comorbidities showed a trend toward increased risk. CONCLUSIONS: LCA and PCA, although minimally invasive, are not void of complications. Most of the complications encountered are mild; however, severe (grade 3 or 4) events may occur in up to 3.6% of patients. PCA may be associated with a higher rate of complications, although most of these are mild and transient. However, on multivariate analysis, the chosen ablative approach (laparoscopic or percutaneous) is not associated with the risk of complications.
Tsivian, M; Chen, VH; Kim, CY; Zilberman, DE; Mouraviev, V; Nelson, RC; Albala, DM; Polascik, TJ
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