Abstract

Objective: We evaluated patients who underwent nephron-sparing surgical or ablative procedures for small renal masses (SRM).

Materials and methods: The study included 31 patients (mean age 59±12 years) who were treated for SRM. Primary treatment modalities were open (OPN) and laparoscopic (LPN) partial nephrectomy in seven patients (22.6%) and 12 patients (38.7%), respectively, cryoablation (CA) in nine patients (29%), and radiofrequency ablation (RFA) in three patients (9.7%). The mean follow-up period was 8.7±7.5 months in patients treated with partial nephrectomy, and 6±8.1 months in patients treated with ablative procedures.

Results: The overall mean tumor size was 2.8±0.9 cm (range 1 to 4.5 cm). The only significant difference between the two partial nephrectomy groups was the ischemic time which was longer in the OPN group (p=0.01). Clinical and procedural parameters were similar in the CA and RFA groups (p>0.05). Histopathologic diagnosis was benign in three (15.8%) of 19 patients treated with partial nephrectomy. Biopsies obtained before ablative procedures yielded a malignant diagnosis in all but one patient whose biopsy material was found insufficient. No intraoperative and postoperative complications were seen in partial nephrectomy and CA groups, whereas massive blood transfusion was required in one patient with coexistent von Willebrand disease, who sustained bleeding after RFA. Two patients who were initially treated with CA and RFA, respectively, exhibited residual tumors in the postoperative period, for which RFA was performed.

Conclusion: Laparoscopic partial nephrectomy has become the treatment of choice in exophytic SRMs in patients with a normal contralateral kidney. Ablative procedures are feasible current treatment options with technical advantages and oncological success in chronic renal disease, bilateral renal tumors, and for tumors smaller than 3 cm.