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Percutaneous cryoablation of renal tumors: limitations and uncertainties

Nature Clinical Practice Urology volume 2, pages 518–519 (2005)Cite this article

Nephron-sparing surgery for small-to-medium sized renal tumors has undoubtedly become a standard of patient management in the 21st century. The recent trends toward nephron sparing stem from an understanding of the natural history of localized renal-cell carcinoma (RCC), and concerns about long-term renal function. Laparoscopic surgery has added another dimension to renal surgery, offering reduced morbidity, often with better access and visualization, but at the price of technical difficulty. Percutaneous approaches are even less invasive, necessitating only intravenous sedation or local anesthesia. Ablation therapy for small renal tumors has dramatically changed the urologist's view of classic extirpative surgery, to an in situ approach, with acceptable results in carefully selected patients.

Cryoablation is the most-studied modality utilized for renal tumor ablation. The essential mechanism of cryoablation is direct thermal killing of cells, followed by thromboembolic ischemia of the targeted tissue. The critical temperature for cell destruction is thought to be −19.4°C, with a treatment goal of −40°C.1 Renal-tumor cryoablation was described as a percutaneous approach under ultrasound guidance by Uchida et al. in 1995.2 Two patients underwent this procedure, with follow-up limited to 1 month and 8 months. The percutaneous approach was subsequently studied in the porcine model,3 and in human studies that described its feasibility, efficacy, and low overall morbidity.4 Though ultrasound-guided cryoablation continues to be evaluated, only safety, and not efficacy, has been studied further.5 At present, MRI seems to be the preferred imaging modality for percutaneous cryoablation. Results have recently been reported for a series of 103 patients treated with percutaneous intraoperative MRI-guided cryoablation over a 5-year period.6 A total of 120 tumors were percutaneously ablated in a broad range of patients, including those with solitary kidneys, multiple or bilateral tumors, or renal insufficiency. Mean follow-up was 35 months (range 4–99 months). Tumor size ranged from 1.1 cm to 7.5 cm, but no mean values were calculated. Of the 103 patients, 91 were classified as having no evidence of disease during the study period. Overall survival was 90.2%, and disease-specific survival was 97%. The fact that 33 of the 120 tumors (27.5%) required at least one re-treatment, with 15 tumors necessitating more than 2 re-treatments, is of some concern. Treatment-related morbidity consisted of a simple access abscess in one patient and a transfusion in another. Guided percutaneous cryoablation has also been described in four patients with von Hippel–Lindau disease,7 with 12–18 months of follow-up. Two patients (with tumor sizes of 5 cm and 3.8 cm) were found to have smaller residual masses requiring short-term re-treatment, which was successful in both cases. Of the remaining two patients, one refused follow-up CT but had a negative renal ultrasound, and the other had a successful primary procedure for a 3.0 cm mass.

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Authors and Affiliations

  1. Emory Clinic/University,

    John G Pattaras & Fray F Marshall

  2. Department of Urology,

    John G Pattaras & Fray F Marshall

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  1. John G Pattaras
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  2. Fray F Marshall
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Correspondence to John G Pattaras.

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The authors declare no competing financial interests.

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Pattaras, J., Marshall, F. Percutaneous cryoablation of renal tumors: limitations and uncertainties. Nat Rev Urol 2, 518–519 (2005). https://doi.org/10.1038/ncpuro0325

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