[Laparoscopy-assisted cryoablation of small kidney tumours]. / Laparoskopisk assisteret kryobehandling af nyretumorer.

INTRODUCTION: During the last 10 years, the number of incidentally found renal tumours has increased from 60 to 75%. Treatment modalities for these small tumours include nefron sparing surgery performed as partial nefrectomy, RFA (radio frequency ablation) or cryoablation. The purpose of this study is to present the first Danish experiences with laparoscopic assisted cryoablation of small kidney tumours. MATERIALS AND METHODS: During a period of 11 months, seven patients were treated with the procedure. All tumours were renal cell carcinomas verified on biopsy. The cryoablation (Oncura) was performed using the SeedNet system. The cryo-ablation was performed using 1.47 mm needles placed in the tumour. Ablation used Argon for freezing and Helium for thawing under high pressure (300 bar). RESULTS: A total of seven patients (median age 77 years (47-83)) were included in the study. The average operating time was 2 hours and 5 minutes. We experienced no complications during surgery and all patients were discharged the day after surgery. All patients were followed with blood samples, x-ray of the thorax and contrast CT of the abdomen. All tumours were found to be well treated, but one demonstrated slight contrast enhancement in the tumour region on control CT. CONCLUSION: Our initial experiences with laparoscopic assisted cryoablation of small kidney tumours show that this treatment modality is safe and effective. However, longer follow-up is needed for this procedure.

[Self-expanding metal stents as palliative treatment of a malign obstruction in the distal part of the ventricle or duodenum]. / Selvekspanderende metalstents ved palliativ behandling af malign obstruktion i distale del af ventriklen eller duodenum.

INTRODUCTION: Self-expanding metal stents (SEMS) have emerged as a simple therapeutic option for the palliation of patients with non-resectable malignant gastric outlet obstruction. We present our results from a three-year period. MATERIALS AND METHODS: Twenty-nine patients with obstruction from tumors in the pancreas (15), bile ducts (3), stomach (9) or transverse colon (2) underwent palliative stenting with a 9-cm-long, 22 mm Wallstent under general anaesthesia. Insertion of the SEMS was done under endoscopic and fluoroscopic control. Biliary stents were implanted prior to or simultaneously with the duodenal stent in eight patients. Seven were covered 6-cm-long, 10 mm Wallstents. Two patients had biliary stents implanted 12 and 262 days, respectively, after the duodenal stent by "rendezvous" technique. RESULTS: The stent deployment was successful in all patients. There were no procedure-related complications, but one patient died of cardiac arrest 12 hours after the operation. Obstruction was relieved in all patients, and an exclusively oral diet was possible for 23 of them. Seven patients with rapid progression of the disease stayed in hospital and died 0-16 days after the procedure. The median length of stay in hospital after the procedure was 2 days (1-32 days), after which the patients stayed at home for 40 days (2-270 days). The overall median survival time was 47 days (median, 0-274 days). There were no late complications (stent migration or perforation), but two patients needed an overlapping stent due to tumor overgrowth. DISCUSSION: Duodenal stents effectively resolve the obstructive symptoms of gastric outlet obstruction. There are few procedure-related complications, and the vast majority of patients can leave hospital and spend the short time left to them at home.