Discussed August 17th, 2006 - VP2-06.Five-year outcomes of laparoscopic partial nephrectomy. B. B. Lane and I.S. Gill, Cleveland Clinic, Cleveland, OH, U.S.A.

VP 2-22. Laparoscopic renal cryoablation: oncological outcomes at 5 years. N. Hegarity, J. H. Kaouk, E. M. Remer, C. M. O’Malley, B. I. Chun, M. Aron, J. R. Colombo, G. P. Haber, O. Ukimura, M. Spaliviero, M. M. Desai, A. C. Novick, and I. S. Gill. Cleveland Clinic, Cleveland, OH, U.S.A.

Together these two abstracts present an excellent overview of the state of the field with regard to nephron sparing surgery using either laparoscopy or needle ablative therapy. While presented separately, I have elected to show the data side by side as it is remarkable how similar the results are at 5 years. In each report, all patients were >/= 5 years out from their initial procedure.

What is apparent from this study is that older, less healthy patients were selected for cryotherapy; yet despite this selection process the overall and the cancer specific survival were remarkably similar. Of note, in the cryoablative group, one patient died of metastatic disease at 19 months; this was diagnosed shortly after his treatment raising the question as to whether the metastatic disease was present, albeit not detectable, at the time of his treatment. While most of the cryotherapy cases were done laparoscopically, a growing use of percutaneous cryoablation is ongoing. What becomes evident is the similarity between this history and that of laparoscopic versus open nephrectomy. Initially, in the early 1990’s, only those in the poorest health, with a predictably shortened lifespan, were deemed candidates for the less invasive laparoscopic approach. When it proved beneficial, the indications were expanded to include the “healthy” patients. I see a parallel situation developing here. Why should only the sickest patient be afforded the least invasive, yet highly effective therapy given these 5 year data? I believe that with time, we will see less and less laparoscopic nephron sparing surgery and more and more percutaneous needle ablative therapy. In sum, it is time for endourologists and urological oncologists to become more proficient at image guided therapy so we can continue to offer all forms of surgical and minimally invasive therapy to our patients with renal cancer.

WCE 2006 - Conference Reports

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Written by Ralph V. Clayman, MD, a Contributing Editor with UroToday.

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