Single Port Access Renal Cryoablation (SPARC): A New Approach
详细信息    查看全文
文摘
Since September 2000, at our department 37 patients with a mean age of 64 years (range 29 to 89) have undergone LRC for computerized tomography or magnetic resonance imaging (MRI) documented renal masses. Mean lesion diameter was 25.7 mm (range 10 to 60). According to tumor position in 22 cases the procedure was performed transperitoneally and in 15 it was done retroperitoneoscopically. Postoperative followup included MRI on postoperative day 1, 1, 3, 6, 12, 18 and 24 months after surgery, and annually thereafter. Moreover, 6 months following the surgical procedure biopsy of the site of the treated neoplasm was performed.

Results

The laparoscopic procedure was successfully completed in all cases. Mean operative time was 194 minutes (range 120 to 300) and mean blood loss was 165.3 ml (range 20 to 900). Final histological evaluation revealed renal cell carcinoma in 29 cases and oncocytoma in 6, while 2 were reported as indefinite. All patients were discharged home after a mean of 3.8 days (range 3 to 7) and returned to normal social life after a mean of 7.3 days (range 5 to 9). Early and postoperative complications were evaluated. Mean diameter of the cryolesion on postoperative day 1 on MRI was 48.2 mm and it progressively decreased during followup. Of the 35 patients with at least 6 months of followup computerized tomography guided biopsy was performed in 25, who were negative for neoplasm.

Conclusions

LRC for small renal masses appears to be a safe, reproducible, minimally invasive technique. Medium term followup in our series is encouraging, although further studies and prolonged followup are needed to access properly the role of this surgical technique.


m/science?_ob=MImg&_imagekey=B7XMT-4HFTKG9-D-1&_cdi=29679&_user=10&_orig=article&_coverDate=10 % 2F31 % 2F2004&_sk=998279995.7998&view=c&wchp=dGLbVzb-zSkWb&md5=2a28036bcfb126cf42f8cf60e5fdb72b&ie=/sdarticle.pdf"">mg name=""pdf"" style=""vertical-align:absmiddle;"" border=""0"" src=""http://www.sciencedirect.com/scidirimg/icon_pdf.gif"" alt=""""> Purchase PDF (64 K)
mlktLink"" id=""mlktLink_2"">
mg src=""/scidirimg/bullet_square.gif"" alt="""">mt=high&_coverDate=07 % 2F31 % 2F2006&_rdoc=1&_orig=article&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=5432e78adf4900c468e3029377fa1e1e"" onMouseOver=""InfoBubble.show('infobubble_2','mlktLink_2')"" onMouseOut=""InfoBubble.timeout()"">Long-term results of cryoablation for renal cancer and ...
Urology
mlktLink_2')"" onMouseOut=""InfoBubble.timeout()"">
mg border=0 src=""/scidirimg/jrn_nsub.gif"" alt=""You are not entitled to access the full text of this document"" title=""You are not entitled to access the full text of this document"" width=12 height=14""> m/science?_ob=ArticleURL&_udi=B6VJW-4KFDJFY-2&_user=10&_coverDate=07 % 2F31 % 2F2006&_rdoc=1&_fmt=high&_orig=article&_cdi=6105&_sort=v&_docanchor=&view=c&_ct=160&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=fe833cc83f8a18867164cabc4c20975d"">Long-term results of cryoablation for renal cancer and complex renal masses
Urology, Volume 68, Issue 1, Supplement 1, July 2006, Pages 2-6
Patrick E. Davol, Brant R. Fulmer, Daniel B. Rukstalis

Abstract
mlktScroll"">
The purpose of this article is to review our experience with 5-year clinical follow-up after cryosurgical ablation of renal neoplasms. A retrospective review of a de-identified database was undertaken to retrieve information on patients with ≥36 months’ follow-up. Patient demographics, tumor characteristics, radiologic follow-up, and disease-free and overall survival data were evaluated. A total of 48 patients, with a median follow-up of 64 months (range, 36–110 months) and an overall survival rate of 89.5 % were identified. Median lesion size was 2.6 cm (range, 1.1–4.6 cm). A total of 12.5 % patients were diagnosed with persistent disease during the follow-up period. The cancer-specific survival rate was 100 % , and the cancer-free survival rate after a single cryoablation procedure was 87.5 % . This improved to 97.5 % after a repeat procedure. No major complications were observed. Our data suggest that cryosurgical ablation of renal neoplasms can lead to acceptable long-term disease-free survival. Careful radiologic follow-up strategies are crucial in monitoring treatment success and identifying those who may require a secondary salvage procedure.

m/science?_ob=MImg&_imagekey=B6VJW-4KFDJFY-2-1&_cdi=6105&_user=10&_orig=article&_coverDate=07 % 2F31 % 2F2006&_sk=999319998.8998&view=c&wchp=dGLbVzb-zSkWb&md5=5cc98af1e7f8f37178cdd2b8e34d82fc&ie=/sdarticle.pdf"">mg name=""pdf"" style=""vertical-align:absmiddle;"" border=""0"" src=""http://www.sciencedirect.com/scidirimg/icon_pdf.gif"" alt=""""> Purchase PDF (94 K)
mlktLink"" id=""mlktLink_3"">
mg src=""/scidirimg/bullet_square.gif"" alt="""">mt=high&_coverDate=01 % 2F31 % 2F2001&_rdoc=1&_orig=article&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=14b8ef5bf75f7758ffc02d10d3813b3b"" onMouseOver=""InfoBubble.show('infobubble_3','mlktLink_3')"" onMouseOut=""InfoBubble.timeout()"">Clinical experience with open renal cryoablation
Urology
mlktLink_3')"" onMouseOut=""InfoBubble.timeout()"">
mg border=0 src=""/scidirimg/jrn_nsub.gif"" alt=""You are not entitled to access the full text of this document"" title=""You are not entitled to access the full text of this document"" width=12 height=14""> m/science?_ob=ArticleURL&_udi=B6VJW-426H6JD-8&_user=10&_coverDate=01 % 2F31 % 2F2001&_rdoc=1&_fmt=high&_orig=article&_cdi=6105&_sort=v&_docanchor=&view=c&_ct=160&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=67daa58efadc6d1cd86b9dfba975a63e"">Clinical experience with open renal cryoablation
Urology, Volume 57, Issue 1, January 2001, Pages 34-39
Daniel B. Rukstalis, Moez Khorsandi, Fernando U. Garcia, David M. Hoenig, Jeffrey K. Cohen

Abstract
mlktScroll"">
Objectives. To evaluate the safety and efficacy of open renal cryoablation of small solid renal masses, since the delivery of freezing temperatures has been shown to effectively ablate solid neoplasms of the liver, uterus, and prostate.

Methods. A total of 29 patients were treated with open renal cryoablation since December 1996 and followed up to evaluate the treatment safety and initial radiographic response.

Results. The median preoperative lesion size was 2.2 cm, with 22 solid renal masses and 7 complex renal lesions. Five serious adverse events occurred in 5 patients, with only one event directly related to the procedure. One patient experienced a biopsy-proven local recurrence, and 91.3 % of patients (median follow-up 16 months) demonstrated a complete radiographic response with only a residual scar or small, nonenhancing cyst.

Conclusions. Open renal cryoablation appears to be a safe technique for the in situ destruction of solid or complex renal masses. However, inadequate freezing of renal cell carcinoma may result in local disease persistence. The expected slow growth rate of small renal cancers necessitates prolonged radiologic follow-up. Continued clinical research is required before renal cryoablation can be considered an acceptable curative treatment for renal cancer.


m/science?_ob=MImg&_imagekey=B6VJW-426H6JD-8-7&_cdi=6105&_user=10&_orig=article&_coverDate=01 % 2F31 % 2F2001&_sk=999429998&view=c&wchp=dGLbVzb-zSkWb&md5=9e5c759c2f30e9e0a07e79cc357c5ed6&ie=/sdarticle.pdf"">mg name=""pdf"" style=""vertical-align:absmiddle;"" border=""0"" src=""http://www.sciencedirect.com/scidirimg/icon_pdf.gif"" alt=""""> Purchase PDF (384 K)
m: 1px solid #CCCCCC;background-color: #F6F6F6"" width=340>
mg src=""/scidirimg/bulletTriang.gif"" alt="""">md5=6ef4944174aa66dfa0d9791f3da47c92"">View More Related Articles
m: 1px solid #CCCCCC; margin: 0px; text-align: center"" onclick=""toggleMLKT('B6X10-4S33RKK-6','/scidirimg/btn_arrow_up_off.gif','/scidirimg/btn_arrow_down_off.gif','http://www.sciencedirect.com/science')"">mg src=""/scidirimg/btn_arrow_up_off.gif"" id=""mlktArrow"" alt="""" border=""0"" onmouseover=""mlktHover(1,'/scidirimg/sci_dir/')"" onmouseout=""mlktHover(0,'/scidirimg/')"">
mg src=""/scidirimg/clear.gif"" width=""1"" height=""10"" border=""0"" alt="""">menubar=yes,status=yes'); doiWin.focus()"">doi:10.1016/j.eururo.2008.03.003 m&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=a143a86ddc585c54adbe80b2046626c3"" target=""sdhelp"" onMouseOver = ""window.status='Help is Available';return true"" onClick=""var helpWin; helpWin=window.open('/science?_ob=HelpURL&_file=doi.htm&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=a143a86ddc585c54adbe80b2046626c3','sdhelp','scrollbars=yes,resizable=yes,directories=no,toolbar=no,menubar=no,status=no,width=760,height=570'); helpWin.focus()"">mg src=""/scidirimg/icon_doi.gif"" width=""136"" height=""14"" alt=""How to Cite or Link Using DOI (Opens New Window)"" title=""How to Cite or Link Using DOI (Opens New Window)"" border=""0"" align=""absmiddle"">
Copyright © 2008 European Association of Urology Published by Elsevier B.V.

Kidney Cancer

© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号

地址：北京市海淀区学院路29号 邮编：100083

电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700