Safety And Short-Term Efficacy Of Laparoscopic Cryoablation For Renal Tumors ≥ 3 Cm: A Multicenter European

Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology;  Clinical Trials / Drug Trials
Article Date: 06 Apr 2008 - 0:00 PDT

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UroToday.com - A multicenter European group reported on the short-term outcomes of laparoscopic cryoablation for renal lesions greater than 3cm in size. Laparoscopic cryoablation has previously been reported as safe and effective for renal tumors <3 cm. The authors studied a group of patients who were considered to be poor candidates for needle ablation therapy.

Patients' data at 7 European centers was prospectively recorded. Procedures were carried out laparoscopically using laparoscopic ultrasound guidance and 17g cryo-needles or Ice Rods. A total of 80 tumors at least 3cm in size (median 3.6) were treated over a 4 year period. Over 80% of the patients had significant comorbidity and were not considered good candidates for partial or radical nephrectomy. Twenty-five percent had a single functioning kidney.

A total of 20 peri-operative complications occurred in 18 of 80 patients (22.5%); 7 major and 13 minor. Major intra-operative complications included 1 nephrectomy and 2 partial nephrectomies for bleeding. Post-operatively, there was 1 hematoma requiring transfusion and 3 myocardial infarctions resulting in one death. Minor complications included chest infection (1), wound infection/hematoma (4), skin burn (1), fever (1), UTI (2) and ileus (4). Only 2 patients required transfusions. Overall, 4 major bleeding complications occurred in the 80 cases (5.0%) and the researchers stated that these could potentially be attributed to the large tumor size.

The conclusion was that peri-operative complications for laparoscopic renal cryoablation are higher in patients with tumors larger than 3 cm; however, major bleeding complications remain relatively uncommon with 17g needles. The emphasis was that more care must be taken not to traumatize the ice ball during treatment, especially in exophytic tumors. Technical tips included freezing to a target of -40 to - 60C and no lower, which may prevent cracking and resultant bleeding complications.

Presented by: F.X. Keeley, MD, et al, at the European Association of Urology - 23rd Annual EAU Congress - March 26 - 29, 2008 - Milan, Italy

Reported by UroToday.com Contributing Editor, Christopher P. Evans, MD

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