Long-term comparative outcomes of partial nephrectomy and cryoablation in patients with solitary kidneys: a single-center analysis.

Autor:	Beksac AT; Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA., Corrigan D; Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA., Abou Zeinab M; Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA., Ferguson E; Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA., Kaviani A; Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA., Schwen ZR; Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA., Kaouk JH; Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA - kaoukj@ccf.org.
Jazyk:	angličtina
Zdroj:	Minerva urology and nephrology [Minerva Urol Nephrol] 2022 Dec; Vol. 74 (6), pp. 722-729. Date of Electronic Publication: 2022 May 27.
DOI:	10.23736/S2724-6051.22.04840-6
Abstrakt:	Background: Patients with solitary kidneys are amenable to postoperative acute kidney injury (AKI) after PN. We compared the functional and oncological outcomes of cryoablation (CA) and PN in patients with a solitary kidney and a cT1a renal mass. Methods: From a single-institution series, we analyzed 74 patients (31 PN, 43 CA) with a solitary kidney who underwent treatment for a cT1a renal mass. The functional outcomes were AKI and estimated glomerular filtration rate (eGFR) preservation. Oncological outcomes were recurrence and death. Linear mixed-effects and logistic regression models were used for functional outcomes analysis, whereas oncological outcomes were analyzed using the Kaplan-Meier method. Results: Median follow-up was 63.9 months. PN group had lower median age (59 years vs. 68, P<0.001) and larger median tumor size (2.80 cm vs. 2.0, p =0.003). AKI was more common in the PN group on postoperative day 1 (58% vs. 2.8%, P<0.001). However, only one patient in the PN group required temporary dialysis in the perioperative period. eGFR preservation was similar at postoperative 3 months (89% vs. 90%, P=0.083), or 12 months (85% vs. 94%, P=0.2) follow-up. CA group had higher recurrence rate (29% vs. 3.2%, P=0.005), and worse recurrence-free survival (P=0.027). Overall survival (OS) was comparable (P=0.31). Conclusions: In a solitary kidney setting, CA is associated with a lower risk of AKI at postoperative day 1 compared to PN. Functional outcome is comparable upon longer follow-up. The local recurrence rates are significantly higher in the CA group with no significant difference in OS.
Databáze:	MEDLINE
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