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For Renal Cryo, Percutaneous Approach Has Advantages

For Renal Cryo, Percutaneous Approach Has Advantages

SEATTLE—In appropriately selected patients, cryoablation of renal cancers results in equal efficacy, shorter hospital stays for patients, and lower costs when performed percutaneously instead of laparoscopically, finds a retrospective study reported at the 32nd Annual Meeting of the Society of Interventional Radiology (abstract 389). J. Louis Hinshaw, MD, of the University of Wisconsin-Madison, presented the study results at a poster session.

The investigators documented outcomes in all patients treated at the University of Wisconsin Hospital and Clinics for single renal tumors with either percutaneous renal cryoablation, in which cryoprobes are inserted under CT or ultrasound imaging (see Figure), or laparoscopic renal cryoablation.

Outcomes were compared between 24 patients treated percutaneously and 55 treated laparoscopically; the choice between procedures had been based on tumor location (with the percutaneous approach favored for posterior and exophytic locations), proximity of the tumor to the bowel (with laparoscopy favored for those closer to the bowel), and patient comorbidities. For follow-up, patients underwent imaging by MRI or CT at intervals of 3 months.

Patients in both study groups averaged about 68 years of age. Mean tumor size was significantly smaller in the percutaneous group, at 2.0 cm (range, 1.2 to 3.8 cm), than in the laparoscopic group, at 2.5 cm (range, 1.3 to 5.3 cm).

Compared with their counterparts treated laparoscopically, patients treated percutaneously had shorter mean hospital stays (1.1 ± 0.3 days vs 2.5 ± 2.2 days; P < .05) and lower hospital charges ($13,704 vs $23,728; P < .001)—a significant difference of 42%.

Dr. Hinshaw noted that the cost of the percutaneous procedure is probably inflated "since we put our patients under general anesthesia and kept them in the hospital overnight, but many centers perform this as an outpatient procedure under conscious sedation."

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