BERKELEY, CA (UroToday.com) - Among 81 renal tumors in 59 patients, laparoscopic cryoablation was successful in 97.5% at 2.3 years follow-up. The authors did the procedure under control with a laparoscopic ultrasound probe using 5 mm cryoprobes; average lesion size was 2.5 cm. If one limits results to only patients with proven renal cancer, then the success rate would be 94% among 34 patients.

This is slightly worse than the 1.4% to 4% recurrence rate expected at 10 years after open partial nephrectomy. However, in both of the authors' patients, a nephrectomy was performed to remove the recurrent or possibly remnant tumor without evidence of spread or metastatic disease. To date, there have been no cases of metastases or cancer related death with cryoablation to the best of my knowledge in more than 6 series comprising over 100 patients. Complication rates after cryotherapy remained far less than after laparoscopic partial nephrectomy as reported by Gill and colleagues: bleeding requiring transfusion (8.5% vs. 1.6%) and urine leakage (4.5% vs. 0%). While it is more satisfying to some to excise the lesion and know that the margins are negative; it is becoming clearer with time that cryoablation or radiofrequency ablation of these small tumors either laparoscopically, or percutaneously, provides excellent results without compromise of the subsequent short-term course and with far fewer complications; both Gill and Landman have independently shown this in their anecdotal series comparing laparoscopic excision to cryoablation. What is needed now are 5 and eventually 10 year data. However, it would seem that this tale is beginning to unfold in a very similar manner to laparoscopic radical nephrectomy 15 years earlier: fewer complications, less hospital stay, quicker convalescence, less pain, and acceptable short term results - but it took the 5 year follow-up before it became widely accepted. The only difference here is that as time passes, the cryoprobes are getting smaller (now 1.7 mm) and imaging is getting better; hence these small renal lesions are becoming ever more amenable to ultrasound, CT fluoroscopy or open MRI percutaneous guidance. It would appear to me that this horse is rounding the corner and heading home, the question is who is in the rider's seat? As such, I believe there needs to be more training in interventional imaging in our residency and postgraduate programs.

J. Urology 175: 1225-1229, April, 2006

Written by Ralph V. Clayman, MD, a Contributing Editor with UroToday.

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