| Background: The incidence of early-stage renal cell carcinoma increases year by year,Nephron Sparing Surgery (NSS) has become the “gold standard” in surgical treatmentof early stage renal cell carcinoma. But the NSS operation is always atechnique-demanding surgery, furthermore，in laparoscopic era，the laparoscopicsuture technique even greatly increases its difficulty, so the laparoscopic nephronsparing operation (LNSS) has not yet been as widespread as expected.Radiofrequency ablation assisted laparoscopic partial nephrectomy (RFAA-NSS) is akind of "zero ischemia" nephron sparing surgery technique developed in recent years.With the use of the coagulation effect of radiofrequency ablation (RFA), RFAA-NSScombines the advantage of RFA and traditional NSS. Without the renal pedicleocclusion and warm ischemia injury, the difficulty of NSS operation decreasesimportantly. Systematic literature research revealed that only a few comparativestudies have accessed the safety and efficacy of RFA-assisted NSS. In view of thisreason, we reviewed our initial experience of RFA-assisted NSS and compare theperioperative and postoperative outcomes between RFA-assisted NSS and traditionalvessel clamping NSS, and further explore the application value of RFAA-NSS inearly-stage renal cell carcinoma.Materials and Methods: The study reviewed the data of46cases of RFAA-NSS and152cases of LNSS operated in the Department of Urology of Renji Hospital from2010January to2013October. With using propensity score matching method, wematched the patients of these two groups by1:1, a retrospective comparative studywas underwent to analysis the perioperative and postoperative data of two groups,including operation time, estimated bleeding loss, hospital stay, postoperativecomplications, tumor control, long-term kidney function recovery, etc. Univariableand muitivariable linear regression analysis was used to explore the factors whichimpacted the changes in renal function after RFAA-NSS.Results: After matching, there were46patients in each group. The differences of age,R.E.N.A.L nephrometry score, tumor size, ASA score and preoperative eGFR were significantly reduced after propensity score matching. The length of stay (2.8vs.7.4d,p<0.001) and operation time (98.6vs.114.1min, p=0.009) was significantly shorterin the group of RFAA-NSS. The decrease of hemoglobin was less in RFAA-NSS(7.0vs.15.4%，p<0.001). The eGFR reduction (7.7vs.16.1ml/min/1.73m2, p=0.006) andthe percent of eGFR reduction in preoperative eGFR (5.5vs.13%, p=0.012) inRFAA-NSS were less than traditional LNSS. There was no obvious difference in theincidence of postoperative complications (15.2vs.17.3%, p=0.951). Pathologicstaging was similar (p=0.353).1patient undergoing RFAA-NSS died by cerebralhemorrhage10months after surgery, other patients were alive during the follow-upperiod. All patients were free of tumor recurrence and metastasis. Preoperative eGFRlevel was the only factor affecting the change of renal function after surgery (β=0.002,p=0.012), the other perooperative factors had no impact on renal function change afterRFAA-NSS.Conclusion: In early-stage renal cell carcinoma, RFAA-NSS has the similarshort-term tumor control effect compared with traditional LNSS, and it has advantagein the protection of renal function. RFAA-NSS is a reliable and safety technique, theincidence of postoperative complication is low. However, when RFAA-NSS appliedinto more complex renal mass, its efficacy and safety remain to be observed. Background: The ablation therapy, such as radiofrequency ablation (RFA) has been asafe and effective treatement for elder RCC patients with comorbid condition.Long-term follow-up studies have shown that the oncological outcome of RFA wascomparable with partial nephrectomy, furthermore RFA has advantages in reducingthe occurrence of complication and protecting renal function. Since2008, hundreds ofpatients have received laparoscopic radiofrequency ablation (LRFA) in Renji Hospital.This study will focus on71patients with at least2-year follow-up and completefollow-up data.Materials and methods: we reviewed a total of97patients receiving LRFA fromDecember2008to March2011in Shanghai Renji Hospital,71patients of them hadcomplete2-year follow-up data. These71patients consisted with44men and27women,68cases single operated lesion,3patients with multiple operated lesions.Lesions were located on the left side in32cases, right side in39cases. The averagediameter was2.5±1.1cm, average R.E.N.A.L nephrometry score was6.4±1.7,preoperative eGFR was (95.3±4.1) ml/min/1.73m2. As for ASA score,1point in30cases,2points in34cases,3points in7cases and the rest7cases with more than3points; As for charlson comorbidity index,0point in25cases,1point in34cases,2points in7cases,3points in5cases. All patients were performed a completepreoperative examination to ensure the toleration of general anesthesia.Results: For71patients, the average operation time was (95.2±33.8) min, the meanblood loss was (40.4±37.9) ml, no patient received blood transfusion, the averagehospital stay was (3.0±1.8) d. There are totally13cases of postoperativecomplication, including clavien1in10cases and clavien2in3cases,3cases ofclavien2included hematuria, urine leakage and ureteral injury. The postoperativepathological results showed that malignant tumor accounted for77.4%, of which51cases was T1a,4cases was T1b. Patients were followed up for average of37.9±9.1months. The recent postoperative eGFR was (92±4.1) ml/min/1.73m2, no significantdifference compared with preoperative eGFR (p=0.571). During follow-up,2patients died by other causes. Primary ablation success rate was98.6%, local recurrence ratewas1.4%, cancer-specific survival rate was100%, overall survival rate was97.2%.Conclusion: RFA is a safe and reliable treatment for small renal mass, especially forelder RCC patients with comorbid condition. postoperative complication rarelyoccurred in RFA. With slight influence on renal function, mid-term oncologicaloutcome of RFA is ideal, but the long-term outcome is still under observation. Background: The incidence of early-stage renal cell carcinoma increases year by year,Nephron Sparing Surgery (NSS) has become the “gold standard” in surgical treatmentof early stage renal cell carcinoma. But the NSS operation is always atechnique-demanding surgery, furthermore，in laparoscopic era，the laparoscopicsuture technique even greatly increases its difficulty, so the laparoscopic nephronsparing operation (LNSS) has not yet been as widespread as expected.Radiofrequency ablation assisted laparoscopic partial nephrectomy (RFAA-NSS) is akind of "zero ischemia" nephron sparing surgery technique developed in recent years.With the use of the coagulation effect of radiofrequency ablation (RFA), RFAA-NSScombines the advantage of RFA and traditional NSS. Without the renal pedicleocclusion and warm ischemia injury, the difficulty of NSS operation decreasesimportantly. Systematic literature research revealed that only a few comparativestudies have accessed the safety and efficacy of RFA-assisted NSS. In view of thisreason, we reviewed our initial experience of RFA-assisted NSS and compare theperioperative and postoperative outcomes between RFA-assisted NSS and traditionalvessel clamping NSS, and further explore the application value of RFAA-NSS inearly-stage renal cell carcinoma.Materials and Methods: The study reviewed the data of46cases of RFAA-NSS and152cases of LNSS operated in the Department of Urology of Renji Hospital from2010January to2013October. With using propensity score matching method, wematched the patients of these two groups by1:1, a retrospective comparative studywas underwent to analysis the perioperative and postoperative data of two groups,including operation time, estimated bleeding loss, hospital stay, postoperative complications, tumor control, long-term kidney function recovery, etc. Univariableand muitivariable linear regression analysis was used to explore the factors whichimpacted the changes in renal function after RFAA-NSS.Results: After matching, there were46patients in each group. The differences of age,R.E.N.A.L nephrometry score, tumor size, ASA score and preoperative eGFR weresignificantly reduced after propensity score matching. The length of stay (2.8vs.7.4d,p<0.001) and operation time (98.6vs.114.1min, p=0.009) was significantly shorterin the group of RFAA-NSS. The decrease of hemoglobin was less in RFAA-NSS(7.0vs.15.4%，p<0.001). The eGFR reduction (7.7vs.16.1ml/min/1.73m2, p=0.006) andthe percent of eGFR reduction in preoperative eGFR (5.5vs.13%, p=0.012) inRFAA-NSS were less than traditional LNSS. There was no obvious difference in theincidence of postoperative complications (15.2vs.17.3%, p=0.951). Pathologicstaging was similar (p=0.353).1patient undergoing RFAA-NSS died by cerebralhemorrhage10months after surgery, other patients were alive during the follow-upperiod. All patients were free of tumor recurrence and metastasis. Preoperative eGFRlevel was the only factor affecting the change of renal function after surgery (β=0.002,p=0.012), the other perooperative factors had no impact on renal function change afterRFAA-NSS.Conclusion: In early-stage renal cell carcinoma, RFAA-NSS has the similarshort-term tumor control effect compared with traditional LNSS, and it has advantagein the protection of renal function. RFAA-NSS is a reliable and safety technique, theincidence of postoperative complication is low. However, when RFAA-NSS appliedinto more complex renal mass, its efficacy and safety remain to be observed. Background: The ablation therapy, such as radiofrequency ablation (RFA) has been asafe and effective treatement for elder RCC patients with comorbid condition.Long-term follow-up studies have shown that the oncological outcome of RFA wascomparable with partial nephrectomy, furthermore RFA has advantages in reducingthe occurrence of complication and protecting renal function. Since2008, hundreds ofpatients have received laparoscopic radiofrequency ablation (LRFA) in Renji Hospital.This study will focus on71patients with at least2-year follow-up and completefollow-up data.Materials and methods: we reviewed a total of97patients receiving LRFA fromDecember2008to March2011in Shanghai Renji Hospital,71patients of them hadcomplete2-year follow-up data. These71patients consisted with44men and27women,68cases single operated lesion,3patients with multiple operated lesions.Lesions were located on the left side in32cases, right side in39cases. The averagediameter was2.5±1.1cm, average R.E.N.A.L nephrometry score was6.4±1.7,preoperative eGFR was (95.3±4.1) ml/min/1.73m2. As for ASA score,1point in30cases,2points in34cases,3points in7cases and the rest7cases with more than3points; As for charlson comorbidity index,0point in25cases,1point in34cases,2points in7cases,3points in5cases. All patients were performed a completepreoperative examination to ensure the toleration of general anesthesia.Results: For71patients, the average operation time was (95.2±33.8) min, the meanblood loss was (40.4±37.9) ml, no patient received blood transfusion, the averagehospital stay was (3.0±1.8) d. There are totally13cases of postoperativecomplication, including clavien1in10cases and clavien2in3cases,3cases ofclavien2included hematuria, urine leakage and ureteral injury. The postoperative pathological results showed that malignant tumor accounted for77.4%, of which51cases was T1a,4cases was T1b. Patients were followed up for average of37.9±9.1months. The recent postoperative eGFR was (92±4.1) ml/min/1.73m2, no significantdifference compared with preoperative eGFR (p=0.571). During follow-up,2patientsdied by other causes. Primary ablation success rate was98.6%, local recurrence ratewas1.4%, cancer-specific survival rate was100%, overall survival rate was97.2%.Conclusion: RFA is a safe and reliable treatment for small renal mass, especially forelder RCC patients with comorbid condition. postoperative complication rarelyoccurred in RFA. With slight influence on renal function, mid-term oncologicaloutcome of RFA is ideal, but the long-term outcome is still under observation. |
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