Clinical Effect Of Laparoscopic Thermal Ablation Assisted Renal Tumor Enucleation In The Treatment Of Early-stage Renal Tumor

Purpose: To investigate the clinical effect of laparoscopic thermal ablation assisted renal tumor enucleation in the treatment of early renal tumors by comparing the postoperative renal function preservation and tumor control between TA-LRTE and LPN.To compare the advantages and disadvantages of laparoscopic microwave ablation assisted renal tumor enucleation(MWA-LRTE)and laparoscopic radio frequency ablation assisted renal tumor enucleation(RFA-LRTE).Materials and methods: Part I: The data of 410 patients undergoing TA-LRTE and 772 patients undergoing LPN from January 2012 to May 2017 at Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine were retrospectively analyzed.The 1:1 propensity score matching was used to eliminate the differences in the control variables between the groups and eliminate the impacts of selection bias on the study results.Perioperative data,postoperative renal function changes,and tumor control were compared between the TA-LRTE and LPN groups.Part II: The data of 288 patients undergoing MWA-LRTE and 122 patients undergoing RFA-LRTE from January 2012 to May 2017 were analyzed retrospectively.The perioperative data,postoperative renal function changes,and tumor control were compared between the two groups.Results: Part I: The post-matching TA-LRTE group(243 cases)and the post-matching LPN group(243 cases)were obtained by the propensity score matching.The TA-LRTE group had a shorter median operative time(89 vs 104 min,p=0.001),less median blood loss(40 vs 50 m L,p<0.001),smaller median ?Hb%(-9.42 vs-11.72 %,p<0.001),and fewer median postoperative hospital stay(5 vs 6 days,p<0.001)than the LPN group.In the TA-LRTE group,renal arteries were temporarily clamped in 3 cases,and renal arteries were not clamped in other cases.The median warm ischemia time of the LPN group was 20 min.The postoperative complication rates in the two groups was 2.47% and 2.88%,respectively,with no significant difference.Median tumor pathological diameter in the TA-LRTE group was less than that in the LPN group(2.5 vs 3.0 cm,p<0.001).Malignant tumors accounted for 72.02% and 75.31% in the two groups,respectively,of which cc RCC accounted for the vast majority.The tumor margins were negative in both groups.The median ?Scr%,median ?e GFR,and median ?e GFR% in the TA-LRTE group were all less than those in the LPN group(1.10 vs 5.54 %,p=0.047;-1.26 vs-7.14 ml/min/1.73 m2,p=0.028;-1.25 vs-6.04 %,p=0.047).The progression rates of malignant tumors in the two groups was 1.14% and 0.55%,respectively.The survival analysis suggested that there was no statistical difference between the two groups in progression free survival.Part II: There were no differences in the basic information of patients between the MWA-LRTE group and the RFA-LRTE group.The median operative time and blood loss were less in the MWA-LRTE group than in the LPN group(84 vs 101 min,p=0.017 and 40 vs 50 m L,p<0.001,respectively).Three cases of the MWA-LRTE group and two cases of the RFA-LRTE group temporarily clamped the renal artery.The other cases did not clamp the renal artery.There was no statistical difference in the postoperative complication rates between the two groups(2.08 vs 3.28%,p=0.473).The proportion of benign lesions was smaller in the MWA-LRTE group than in the RFA-LRTE group(27.43 vs 43.44%,p<0.001).There was no difference between the groups in median pathological diameter(2.0 vs 2.0 cm,p=0.150).The tumor margins were negative in both groups.There was no significant difference in the long-term changes in Scr and e GFR between the two groups.The recurrence rates of malignant tumors were 0.48% and 1.45%,respectively.The survival analysis suggested that the two groups had comparable tumor control.Conlusions: TA-LRTE does not need to clamp the renal artery,avoids warm ischemia injury,and can better protect patients' long-term renal function compared with LPN.There are also certain advantages in the operative time,blood loss,and early postoperative rehabilitation.TALRTE has comparable tumor control effects to LPN.TA-LRTE is the more recommended surgical method for well-selected patients with early renal tumors.MWA-LRTE and RFA-LRTE have comparable long-term renal function preservation and tumor control.However,compared with RFALRTE,MWA-LRTE has more advantages in ablation efficiency,which can shorten the operative time to a certain extent and reduce the blood loss.TA-LRTE is a surgical technique worthy of promotion,but the renal function preservation effect and oncological outcome of TA-LRTE still need to be verified by large-scale prospective randomized controlled studies and long-term follow-up studies.