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Role of Tumor Location and Provider Specialty in Selecting Patients for Percutaneous Versus Surgical Cryoablation of the Small Renal Mass
Christopher J Long1, Daniel J Canter2, Marc C Smaldone2, Ervin Teper2, David YT Chen2, Richard Greenberg2, Rosalia Viterbo2, Robert G Uzzo2, Alexander Kutikov2
1Temple University Hospital, Philadelphia, PA;2Fox Chase Cancer Center, Philadelphia, PA

Introduction: To determine how tumor location and provider specialty effect selection of tumors for surgical (SCA) and percutaneous (PCA) cryoablation of small renal masses (SRMs).
Materials & Methods:MEDLINE search was performed of the published literature in which cryoablation was used as therapy for localized renal masses. Tumor location was recorded amongst three categories: (1) anterior, posterior, and lateral; (2) upper, mid, and lower pole; and (3) endo-, meso-, and exophytic. Reports were stratified by medical specialty, defined as Urology, Radiology, or both.
Results:46 studies, encompassing 1,955 lesions treated by surgical (n=29) or percutaneous (n=17) cryoablation were analyzed. Reporting rates for SCA versus PCA are 35% (10/29) vs. 47% (7/17) for anterior/posterior lesions. SCA was performed in 40% of reported anterior lesions, compared to PCA in 75% of posterior lesions. Reporting rates for Urologists were 31% for SCA and 60% for PCA. Radiologists reported location in 20% of their reports. The combined approach report rates were SCA 67% and PCA 50%.
Conclusions:While efficacy does not differ between SCA and PCA, health care cost and patient morbidity significantly favors PCA. Tumor location is classically the primary determinant in selection of SCA vs. PCA, yet data regarding tumor location is vastly under reported in the literature. Moreover, over 30% of lesions treated with surgical cryoablation appear to be posterior lesions. These findings raise significant quality of care issues, since some of the most co-morbid urologic patients appear to be exposed to unnecessary risks with SCA.


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