Introduction

Objective: To compare the surgical, oncological, and functional outcomes of laparoscopic and percutaneous cryoablation for the treatment of small renal masses.

Methods

A systematic review of the literature was performed through March 2016 using PubMed, Scopus, and Ovid databases. Article selection proceeded according to the search strategy based on PRISMA criteria. Only studies comparing laparoscopic and percutaneous kidney cryoablation were included in the meta-analysis.

Results

Eleven studies were selected for the analysis including 1725 cases: 804 (46.6%) percutaneous and 921 (53.4%) laparoscopic cryoablation. Included studies were all retrospective comparative ones. Percutaneous cryoablation was performed more frequently for posterior tumors (p<0.001), whereas laparoscopy was more common for endophytic lesions (p=0.01). The length of follow-up was longer for laparoscopy (p<0.001). Percutaneous cryoablation was associated with a significantly shorter hospital stay (p<0.001). A lower likelihood of residual disease was recorded for laparoscopic (p=0.003), whereas tumor recurrence rate favored percutaneous cryoablation (p=0.02). The two procedures were similar for recurrence free survival (p= 0.08), and overall survival (p=0.51). No significant difference was found in post-operative eGFR (p=0.78).

Conclusions

Laparoscopic and percutaneous kidney cryoablation offer similar favorable oncological outcomes with minimal impact on renal function. The percutaneous access can offer shorter hospital stay and faster recovery, which can be appealing in an era of cost restraint. Determining which approach to use in clinical practice will depend on the available technology and specific expertise at each center.

Funding

none