Category: Clinical Oncology: Outcomes & Complications

MP23-18 - Percutaneous Cryoablation vs Partial Nephrectomy: Trade-off between Renal Functional Outcomes and Complications in Matched-Paired Elderly Patients

Sat, Sep 22
2:00 PM - 4:00 PM

Introduction & Objective : Partial nephrectomy (PN) and percutaneous cryoablation (PCA) are both available treatment options for localized renal cell carcinoma, particularly in the elderly population. There is a paucity of data regarding the functional impact of these procedures. We aimed to compare renal functional outcomes after PCA and PN in patients over 75 years old.


Methods :

Elderly patients who underwent PCA or PN for a renal mass at our institution were extracted from the prospectively maintained dataset (2006-2017). Demographic characteristics, and renal function were recorded.  Patients in treatment cohorts were 1:1 matched by propensity score analysis via a greedy algorithm. Perioperative outcomes were considered. Specifically for the purpose of the study, glomerular filtration rate (GFR) data were collected at baseline and at multiple time points postoperatively and analyzed by linear mixed effects model. Time was treated as a factor variable to account for any non-linear time trend that may be present. After modeling, contrast comparisons were used to assess GFR differences between PN or PCA at 1 day, 3 days, 1 month, 3 months, 6 months, and 12 months postoperatively (Table 1). 


Results : 120 PCA and 192 PN patients over 75 years were extracted. After matching, 65 vs 65 patients were analyzed and had comparable baseline data. GFR was comparable between the groups at every time point analyzed (Figure 1). Conversely, a significantly higher rate of postoperative complications (Clavien 1-2) was found in the PN cohort (32% vs 9.2%; p=0.001) mostly secondary to more low-grade complications (17, 25.37%).


Conclusions : We found no significant differences in renal functional outcome assessed by GFR between PCA and PN within 1-year postoperative follow-up. Further randomized studies are required to confirm our findings.

Juan Garisto

MD
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
Cleveland, Ohio

Juan Garisto, MD is an Advanced Laparoscopy & Robotics clinical fellow at Cleveland Clinic, Cleveland, OH, United States under the mentorship of Dr. Jihad Kaouk. He completed a Society of Urologic Oncology fellowship at the University of Toronto and did his urology residency training at Complejo Hospitalario Dr. A.A.Madrid in Panama City, Panama.

His current research interest in single port surgery and multidisciplinary management of urologic malignancies, in particular kidney and bladder cancer.

Sherif Armanyous

MD
Cleveland Clinic Foundation
Cleveland, Ohio

Riccardo Bertolo

MD
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
Turin, Piemonte, Italy

Riccardo Bertolo, MD
Research Fellow, Robotic Urology,
Cleveland Clinic, Cleveland, OH, USA
PhD Candidate, Bioengineering in Medical/Surgical Sciences
Turin Politechnic, Italy

Julien Dagenais

MD
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
Cleveland, Ohio

Daniel Sagalovich

MD
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
Cleveland, Ohio

Jose Agudelo

MD
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
Cleveland, Ohio

Robert Stein

MD
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
Cleveland, Ohio

Jihad Kaouk

Professor and Director, Center for Robotic and Image Guided Surgery Vice Chair, Surgical Innovations
Glickman Urologic Institute, Cleveland Clinic
Cleveland, Ohio

Jihad Kaouk, MD FACS

Dr. Jihad Kaouk is an American Board certified Urologist and Director, Center of Robotic and Image Guided Surgery at the Cleveland Clinic Glickman Urological Institute. He also serves as Professor of Surgery at the Cleveland Clinic Lerner College of Medicine, Vice Chair for Surgical Innovations and chair holder for the Zegarac-Pollock Endowed Chair in laparoscopic and robotic surgery.
In Innovations, he has performed several first ever done surgical procedures, including the first Robotic single port surgery through the belly button in 2008, the first completely transvaginal kidney removal in 2009, and the first robotic perineal prostatectomy in 2014 Dr. Kaouk holds 2 USA patents for medical devices used during partial nephrectomy and in robotic surgery.

Since 2005, Dr. Kaouk has served on committees at the national and local levels. From 2005-2008, he served in the American Urological Association’s Urologic Diagnostic and Therapeutic Imaging Task Force, from 2006-2010 he was on the Guidelines for the Management of small Renal Masses committee. Currently Dr Kaouk serves as Chairman elect on the AUA New Technology and Imaging committee, and is President Elect of (SURS) Society of Urologic Robotic Surgery. Dr Kaouk is associate editor of Urology journal.

Dr Kaouk have lectured in 130 scientific meetings, chaired 24 urologic meeting and performed live surgery in 18 medical centers worldwide. He authored 460 peer reviewed scientific publication, 26 book chapters and hundreds of scientific abstracts and surgical movies. Dr Kaouk received 32 honors and awards including Cleveland clinic innovator award twice, Teacher of the Year award, and EndoUrology 2017 Best Fellowship Program Director Award.

Presently, Dr Kaouk holds membership with the American Urological Association, the Endourological Society, Society of Urologic Oncology, Society of Robotic Surgery, and the Lebanese Order of Physicians. He is a fellow of the American college of Surgeons.