Renal function outcomes after laparoscopic renal cryoablation.

BACKGROUND AND PURPOSE: Laparoscopic cryoablation (LCA) has emerged as an alternative to conventional surgery for the management of a T(1) renal mass; however, only few data are available on its functional outcomes. We assessed renal function changes after LCA in patients with normal renal function (NRF) and preexisting chronic renal insufficiency (CRI). PATIENTS AND METHODS: Data of consecutive patients who were undergoing LCA between 2000 and 2008 at Duke University Medical Center were analyzed. Renal function parameters were obtained preoperatively, at discharge, and at 6, 12, and 24 months postoperatively. Serum creatinine (sCr) levels and estimated glomerular filtration rates (eGFR) were compared over a 2-year follow-up. RESULTS: Of 67 patients, 22 (33%) had CRI at baseline. These patients were older, had larger tumors (2.5 vs 2.0 cm, P=0.039), and a higher incidence of multiple lesions (22.7% vs 4.4%, P=0.034). Compared with baseline, sCr was significantly increased and eGFR declined at discharge, 6, 12, and 24 months in both NRF and CRI groups. Median sCr increase was 0.1 mg/mL, eGFR declined by 4.2 mg/mL/1.73 m(2) in the CRI cohort and up to 8.8 mg/mL/1.73m(2) in NRF patients (all P<0.05) during the follow-up. Compared with baseline, however, no significant changes were noted in the distribution of CRI categories at any time (all P>0.05). CONCLUSIONS: A minimal decline in renal function can be appreciated in patients undergoing LCA at midterm follow-up. This decline is no higher in CRI than in NRF patients. LCA offers excellent renal function outcomes at 2 years follow-up. Specifically, in patients with CRI, LCA offers excellent preservation of renal function.

Duke Scholars

Author Thomas James Polascik Urology