Laparoscopic Partial Nephrectomy Versus 1aparoscopic Cryoablation For The Small Renal Masses: A Meta-analysis Of Safety And Efficacy

Objective:To evaluate the safety and efficacy of Laparoscopic partial nephrectomy(LPN)versus 1aparoscopic cryoablation(LCA)for the small renal masses(SRMs).Methods:The databases of PubMed,SCI,Ovid,The Cochrane Library,CNKI,CBM,VIP and Wangfang Data,Were searched to controlled clinical trial about LPN versus LCA for the treatment of small renal tumor.The retrieval time span was from inception to Apr 2016.The studies were screened according to the inclusion and exclusion criteria,the date were extracted and the quality was evaluated by 2 reviewers independently.And then the Meta-analysis was conducted using RevMan 5.3 software.Results:A total of 9 studies were included,and 748 cases were involved.The meta-analysis showed that comparing with LPN,LCA showed significantly shorter the operation time [MD=42.75,95%CI(12.19 ~ 73.31),P=0.006],lower intraoperative blood loss [MD=190.73,95%CI(126.67~254.78),P=0.000],shortening hospital stay [MD=2.23,95%CI(0.17~4.28),P=0.030],lower transfusion rate [OR=3.54,95%CI(1.18~10.59),P=0.020],lower rate of postoperative glomerular filtration levels [MD=10.30,95%CI(5.38~15.24),P=0.000],lesser complications [OR=3.90,95%CI(1.84~8.24),P=0.000],higher risk of local recurrence [OR=0.13,95%CI(0.04~0.44),P=0.000],higher risk of distant metastasis [OR=0.16,95%CI(0.03~0.78),P=0.020],but there were no significant differences in postoperative creatinine rise and blood transfusion rate(P>0.05).Conclusions:LCA is preferred to LPN in clinical application for its advantages of peri-operative safety and protection renal function;however,LCA may have a higher risk of local recurrence and distant metastasis,it is still prudent to choose the surgical case.