經皮冷凍治療與腹腔鏡部分腎切除術於 cT1a/T1b 腎細胞癌之療效比較

陳正宇、蘇家震、黃冠華

奇美醫療財團法人永康奇美醫院外科部泌尿外科

Comparative Outcomes of Cryotherapy versus Laparoscopic Partial Nephrectomy for cT1a/T1b Renal Cell Carcinoma

Cheng-Yu Chen, Chia-Cheng Su、Steven Kuan-Hua Huang

Division of Urology,Department of Surgery,Chi Mei Medical Center,Tainan,Taiwan

Purpose: Nephron-sparing approaches such as laparoscopic partial nephrectomy (LPN) and percutaneous cryoablation (CA) are widely used for localized renal cell carcinoma (RCC). Evidence directly comparing these two modalities in cT1a and cT1b tumors with mid-term follow-up remains limited.

Materials and Methods: We retrospectively reviewed 71 patients with biopsy-proven cT1a/T1b RCC treated between 2016 and 2023. Forty patients underwent LPN and thirty-one underwent image-guided CA. Primary outcomes included local tumor control and overall survival (OS) at 24 months. Secondary outcomes assessed renal function preservation and perioperative morbidity.

Results: Median tumor size was 2.9 cm in the LPN group and 3.1 cm in the CA group. At two-year follow-up, local recurrence was detected in 1 patient (2.5%) in the LPN group and 2 patients (6.5%) in the CA group (p=0.21). OS was comparable (97.5% vs 96.8%, p=0.73). A decline in estimated glomerular filtration rate ≥20% was more frequent after LPN (15.0%) compared with CA (6.5%) (p=0.04). Perioperative complications (Clavien–Dindo grade ≥II) occurred in 5 patients (12.5%) in the LPN group and 2 patients (6.4%) in the CA group (p=0.05).

Conclusions: Both LPN and CA achieved excellent short-term oncologic outcomes for cT1a/T1b RCC. LPN showed a trend toward lower local recurrence, while CA demonstrated better renal function preservation and fewer perioperative complications. CA may serve as a safe alternative for carefully selected patients, particularly those with higher surgical risk, though longer follow-up is required to confirm oncologic durability.