First Prize: Laparoscopic Renal Cryoablation: Efficacy And Complications For Larger Renal Masses

Main Category: Urology / Nephrology
Article Date: 16 Aug 2008 - 0:00 PST

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UroToday.com - Cryotherapy is increasingly becoming an acceptable treatment for small (< 3 cm) localized renal tumors. Dr. Jaime Landman and colleagues report findings similar to our own clinical experience - with increased complications and morbidity in patients with lesions > 3 cm treated with cryotherapy.

While they report only their laparoscopic experience with this tumor ablative technology, we have also noted the same findings with our percutaneous cryotherapy experience. However, it must be remembered that the patient with a > 3 cm tumor in their study also was significantly older and had a significantly higher operative risk (ASA score). It appears that larger tumors requiring multiple probes are more likely to bleed and require transfusion (62%). The average size of the tumor was 4.7 cm in the patients receiving a blood transfusion. Two deaths occurred in the large tumor cryotherapy group from aspiration pneumonia (1) and myocardial infarction (1). This group also had three other complications including cerebrovascular accident (1), myocardial infarction (1) and pulmonary embolus (1). There were no tumor recurrences in the < 3 cm cryotherapy group; and one recurrence in the > 3 cm cryotherapy group in a solitary kidney which had undergone an ablative procedure at an outside institution with residual rim enhancement.

From our own similar experience, we have considered it more prudent to reserve cryotherapy for the < 3 cm renal tumors and laparoscopic partial nephrectomy for the larger lesions. Of course, concurrent patient morbidity is often a confounding factor in this decision making process.

Lehman DS, Hruby GW, Phillips CK, McKiernan JM, Benson MC, Landman J
J Endourol. 2008 Jun;22(6):1123-7
doi:10.1089/end.2008.0077

Reported by UroToday.com Contributing Editor Elspeth M. McDougall, MD, FRCSC

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