Preoperative Aspects and Dimensions Used for Anatomical Score Predicts Treatment Failures in Laparoscopic Cryoablation of Small Renal Masses

Objectives: To determine the potential of the preoperative aspects and dimensions used for anatomical (PADUA) classification score as a predictive tool in relation to residual unablated tumor and disease-free survival (DFS) following laparoscopy-assisted cryoablation (LCA) of small renal masses. Patients and Methods: A multi-institutional cohort of 212 patients with biopsy-verified T1N0M0 renal malignancies treated with LCA between August 2005 and September 2014 were retrospectively investigated with respect to oncologic outcomes. Results: The preoperative PADUA score was found to be low (6-7 points) in 70 patients (33%), moderate (8-9 points) in 86 patients (40.6%), and high (10-14 points) in 56 patients (26.4%). The mean PADUA score was significantly higher in cases (n=11) with residual unablated tumor (10.4 vs 8.1, p<0.001) and in cases (n=8) with local tumor recurrence (9.8 vs 8.1, p<0.001) at a mean follow-up of 37 (95% confidence interval: 34-40) months. The estimated 2-, 3-, and 5-year DFS for patients with a moderate PADUA score was 96%, 94%, and 94% compared with 95%, 87%, and 81%, respectively, for patients with a high PADUA score (log-rank, p=0.003). The PADUA score did not predict overall survival. Conclusion: The PADUA score significantly predicts residual unablated tumor and DFS following LCA. Further studies are needed to validate the efficacy of the PADUA score in relation to oncologic outcomes following ablative procedures.