TY - JOUR
T1 - Complications of Laparoscopic and Percutaneous Renal Cryoablation in a Single Tertiary Referral Center
AU - Tsivian, Matvey
AU - Chen, Valerie H.
AU - Kim, Charles Y.
AU - Zilberman, Dorit E.
AU - Mouraviev, Vladimir
AU - Nelson, Rendon C.
AU - Albala, David M.
AU - Polascik, Thomas J.
N1 - Funding Information:
Although percutaneous and laparoscopic renal cryoablation are considered minimally invasive, they are not without complications. These data are valuable for patient counseling. PCA may be associated with a higher rate of complications, although most of these are mild and transient. LCA may have a higher incidence of severe complications, although the incidence of severe complications in this group may have been artificially augmented by the misinterpretation of radiographic findings at outside institutions. Severe complications (Clavien grade 3 or 4) can occur in up to 3.6% of renal cryoablation patients. On multivariate analysis the chosen ablative approach (laparoscopic or percutaneous) is not associated with the risk of complications. Younger patients are at an increased risk of postoperative complications, whereas BMI plays a protective role, important for the percutaneous approach for the thermo-isolating qualities of adipose tissue. Author contributions: Thomas J. Polascik had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Tsivian, Nelson, Polascik. Acquisition of data: Tsivian, Kim, Zilberman, Mouraviev. Analysis and interpretation of data: Tsivian, Chen, Kim. Drafting of the manuscript: Tsivian, Chen, Kim. Critical revision of the manuscript for important intellectual content: Mouraviev, Albala, Nelson, Polascik. Statistical analysis: Tsivian, Chen. Obtaining funding: None. Administrative, technical, or material support: None. Supervision: Nelson, Albala, Polascik. Other (specify): None. Financial disclosures: I certify that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg, employment/ affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: Thomas J. Polascik received research support from Galil Medical. Rendon C. Nelson received research support from Covidien and is a consultant for GE Healthcare. David M. Albala is a consultant for GSK and Merck and is a consultant/investor at Applied Medical. Funding/Support and role of the sponsor: None.
PY - 2010/7
Y1 - 2010/7
N2 - 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.
AB - 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.
KW - Complications
KW - Cryoablation
KW - Laparoscopic
KW - Percutaneous
KW - Renal neoplasm
UR - http://www.scopus.com/inward/record.url?scp=77952882722&partnerID=8YFLogxK
U2 - 10.1016/j.eururo.2010.03.035
DO - 10.1016/j.eururo.2010.03.035
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C2 - 20363550
AN - SCOPUS:77952882722
VL - 58
SP - 142
EP - 148
JO - European Urology
JF - European Urology
SN - 0302-2838
IS - 1
ER -