Initial Experience In Renal Cryosurgery For Large Renal Lesions

Main Category: Urology / Nephrology
Article Date: 14 Jun 2008 - 1:00 PST

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ORLANDO, FL (UroToday.com) - Cryoablation of small renal masses (i.e. T1a < 4cm) works. Whether applied laparoscopically, or more recently, percutaneously, the 5 year data support this minimally invasive approach which in its latter form, often requires a single needle "stick" of < 3 mm diameter and discharge from the hospital the same day or the next morning.

So the natural next question is: "Can this minimally invasive and highly effective therapy be applied to larger renal lesions (i.e. T1b 4-7 cm)?"

The answer appears to be a cautious "maybe".

In this study, 11 patients (9 percutaneous and 2 laparoscopic) with a renal mass of 6 cm (4-7 cm range) were treated with a double freeze (8 minutes each) cycle with 4-6 cryoprobes (Galil Inc.); there were no major complications, no blood transfusions, and a median hospital stay of 1 day. Follow-up was brief in both groups (8 months for the percutaneous and 18 months for the laparoscopic patients), during which 3 percutaneous and 1 laparoscopic case (36 %!) required retreatment. While the lack of lesion progression or metastatic disease in this series is encouraging, it is certainly not yet convincing; that will require at least 5 year data. Be that as it may, one has to believe that as the technology improves (i.e. both the ability to freeze and the ability to measure the absolute area of the freeze) these larger lesions, similar to their smaller versions, will likely fall prey to needle ablation. However, as with laparoscopic radical nephrectomy, cautious practitioners will rightly require, at minimum, detailed 5 year data prior to more widespread application of "the big freeze."

Presented by Justin Sausville, MD, James Borin, MD, and Michael W. Phelan, MD, at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Reported by UroToday.com Medical Editor Ralph V. Clayman, MD

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