In a recent review, P. E. Davol, D. Rukstalis and colleagues from Geisinger Health System in Danville, Pennsylvania, the long-term results of cryosurgical ablation of renal neoplasms is reported. The report is published in the July 2006 issue of Urology.

A retrospective review of a cohort of 48 patients treated with either open (n = 24) or laparoscopic (n = 24) cryoablation of worrisome renal masses who had at least 36 months of follow-up (median 64 months) was completed. Patient demographics, tumor characteristics, radiologic follow-up and disease-free and overall survival data were evaluated. Follow-up imaging was by MRI very frequently initially but has evolved to one post-op MRI at 3-months post-op and then every 6 months thereafter. Radiographic success was defined as an involuted scar or fibrosis without evidence of growth or enhancement on the most recently available imaging study.

Analysis of the results showed a mean age of the cohort to be 62 years. The mean size of the renal mass was 2.6 cm. Forty-four lesions were exophytic, 4 were central, 38 masses were solid, and 11 were cystic but suspicious. A total of 12.5% of patients were diagnosed with persistent disease during the follow-up period. The failures were treated with either laparoscopic nephrectomy (n = 2), laparoscopic partial nephrectomy (n = 1), repeat cryoablation (n = 1) and one elected observation. This patient experienced distant lung metastasis after 60 months of follow-up. Overall cancer specific survival was 100% and the cancer-free survival rate after a single cryoablation procedure was 87.5%. This improved to 97.5% after a repeat procedure. No major complications were observed.

This data suggests that cryosurgical ablation of renal neoplasms can lead to acceptable long-term disease free survival. Careful radiologic follow-up strategies are crucial in monitoring treatment success and identifying those who may require a secondary salvage procedure.

Davol PE, Fulmer BR, Rukstalis DB

Urology. 2006 Jul; 68(supp 1A):2-6

Written by Michael J. Metro, MD, a Contributing Editor with UroToday.

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