Laparoscopic Cryoablation For Small Renal Masses: Three-Year Follow-up

Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology
Article Date: 20 May 2007 - 0:00 PDT

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UroToday.com- Among 22 biopsy proven renal cancers treated by laparoscopic cryoablation, the cancer specific survival was 100% and no metastatic disease developed with a MINIMUM follow-up of 3 years (mean 3.8 yrs.). In this series, the average area of non-enhancement on radiographic follow-up actually was larger or similar in size to the lesion for the first 6 months. While the average tumor was 2.1 cm, the range was up to 4.0 cm. Of note, the majority of the tumors were exophytic (75%); however, both endophytic (14%) and hilar (11%) lesions were treated. There was one major complication in a patient with an endophytic tumor hemorrhage and a urine leak both of which responded to conservative, therapy (i.e. transfusion and ureteral stent placement). There was one recurrence noted; a patient with a hilar tumor developed evidence of tumor recurrence, but due to worsening of her co-morbidities, refused further therapy. These data are very similar to the data reported by Gill and colleagues at the Cleveland Clinic in which among 40 patients, after a minimum of 4 years of follow-up, the recurrence rate was 5%, with a cancer specific survival of 100%.

It would appear that laparoscopic needle-based cryoablation of renal masses is a reasonable approach especially in the high risk, older patient with a < 3 cm exophytic lesion. However, favorable five and ten year data will be needed before this approach can be viewed as a "standard of care".

Having written this, it is important to realize that many of the needle-based therapies are now being administered percutaneously using MRI or CT/fluoroscopic guidance and that the needles (both cryotherapy and radiofrequency) are getting smaller and more powerful. The day is not too far distant, when percutaneous needle ablative therapy will become a widely accepted standard of care, the only question will be the size criteria for treatment and the approach vs. exclusion of hilar tumors. At the moment, nearly all of the data coming from major medical centers seem to be favorable.

Weld KJ, Figenshau RS, Venkatesh R, Bhayani SB, Ames CD, Clayman RV, Landman J

Urology 69(3): 448-451, March 2007
Reviewed by UroToday.com Contributing Editor Ralph V. Clayman, MD

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