Laparoscopic Renal Cryoablation

Abstract

In light of evidence linking radical nephrectomy and consequent suboptimal renal function to adverse cardiovascular events and increased mortality, research into nephron-sparing techniques for renal masses widely expanded in the past two decades. The American Urological Association (AUA) guidelines now explicitly list partial nephrectomy as the standard of care for the management of T1a renal tumors. Because of the increasing utilization of cross-sectional imaging, up to 70% of newly detected renal masses are stage T1a, making them more amenable to minimally invasive nephron-sparing therapies including laparoscopic and robotic partial nephrectomy and ablative therapies. Cryosurgery has emerged as a leading option for renal ablation, and compared with surgical techniques it offers benefits in preserving renal function with fewer complications, shorter hospitalization times, and allows for quicker convalescence. A mature dataset exists at this time, with intermediate and long-term follow-up data available. Cryosurgical recommendations as a first-line therapy are made at this time in limited populations, including elderly patients, patients with multiple comorbidities, and those with a solitary kidney. As more data emerge on oncologic efficacy, and technical experience and the technology continue to improve, the application of this modality will likely be extended in future treatment guidelines.

Keywords

renal masses - cryoablation - cryosurgery - laparoscopic cryoablation

• References

• 1 Jayson M, Sanders H. Increased incidence of serendipitously discovered renal cell carcinoma. Urology 1998; 51 (2) 203-205
• 2 AUA Guideline for Management of Clinical Stage 1 Renal Mass. Available at: http://www.auanet.org/education/guidelines/renal-mass.cfm
• 3 Berger A, Kamoi K, Gill IS, Aron M. Cryoablation for renal tumors: current status. Curr Opin Urol 2009; 19 (2) 138-142
• 4 El Dib R, Touma NJ, Kapoor A. Cryoablation vs radiofrequency ablation for the treatment of renal cell carcinoma: a meta-analysis of case series studies. BJU Int 2012; 110 (4) 510-516
• 5 Williams SK, de la Rosette J, Landman J, Keeley FX. Cryoablation of small renal tumors. European Association of Urology 2007; 5: 206-218
• 6 Ahmed M, Brace CL, Lee Jr FT, Goldberg SN. Principles of and advances in percutaneous ablation. Radiology 2011; 258 (2) 351-369
• 7 Gill IS, Novick AC, Soble JJ , et al. Laparoscopic renal cryoablation: initial clinical series. Urology 1998; 52 (4) 543-551
• 8 Weld KJ, Figenshau RS, Venkatesh R , et al. Laparoscopic cryoablation for small renal masses: three-year follow-up. Urology 2007; 69 (3) 448-451
• 9 Tsivian MM, Caso J, Kimura M, Polascik TJ. Renal function outcomes after laparoscopic renal cryoablation. J Endourol 2011; 25 (8) 1287-1291
• 10 Gunn A, Gervais D. Percutaneous ablation of the small renal mass—techniques and outcomes. Semin Intervent Radiol 2014; 31 (1) 33-41
• 11 Kunkle DA, Egleston BL, Uzzo RG. Excise, ablate or observe: the small renal mass dilemma—a meta-analysis and review. J Urol 2008; 179 (4) 1227-1233 , discussion 1233–1234
• 12 Weight CJ, Kaouk JH, Hegarty NJ , et al. Correlation of radiographic imaging and histopathology following cryoablation and radio frequency ablation for renal tumors. J Urol 2008; 179 (4) 1277-1281 , discussion 1281–1283
• 13 Aron M, Kamoi K, Remer E , et al. Laparoscopic renal cryoablation: 8-year, single surgeon outcomes. Urology 2010; 183: 889-895
• 14 Tanagho YS, Roytman TM, Bhayani SB , et al. Laparoscopic cryoablation of renal masses: single-center long-term experience. Urology 2012; 80 (2) 307-314
• 15 Desai MM, Aron M, Gill IS. Laparoscopic partial nephrectomy versus laparoscopic cryoablation for the small renal tumor. Urology 2005; 66 (5, Suppl): 23-28
• 16 Hruby G, Reisiger K, Venkatesh R, Yan Y, Landman J. Comparison of laparoscopic partial nephrectomy and laparoscopic cryoablation for renal hilar tumors. Urology 2006; 67 (1) 50-54
• 17 Klatte T, Grubmüller B, Waldert M, Weibl P, Remzi M. Laparoscopic cryoablation versus partial nephrectomy for the treatment of small renal masses: systematic review and cumulative analysis of observational studies. Eur Urol 2011; 60 (3) 435-443
• 18 Tsivian M, Lyne JC, Mayes JM, Mouraviev V, Kimura M, Polascik TJ. Tumor size and endophytic growth pattern affect recurrence rates after laparoscopic renal cryoablation. Urology 2010; 75 (2) 307-310
• 19 Guazzoni G, Cestari A, Buffi N , et al. Oncologic results of laparoscopic renal cryoablation for clinical T1a tumors: 8 years of experience in a single institution. Urology 2010; 76 (3) 624-629
• 20 Wyler SF, Sulser T, Ruszat R , et al. Intermediate-term results of retroperitoneoscopy-assisted cryotherapy for small renal tumours using multiple ultrathin cryoprobes. Eur Urol 2007; 51 (4) 971-979
• 21 Littrup PJ, Jallad B, Vorugu V , et al. Lethal isotherms of cryoablation in a phantom study: effects of heat load, probe size, and number. J Vasc Interv Radiol 2009; 20 (10) 1343-1351
• 22 Young JL, McCormick DW, Kolla SB , et al. Are multiple cryoprobes additive or synergistic in renal cryotherapy?. Urology 2012; 79 (2) e1-e6
• 23 Haber GP, Lee MC, Crouzet S, Kamoi K, Gill IS. Tumour in solitary kidney: laparoscopic partial nephrectomy vs laparoscopic cryoablation. BJU Int 2012; 109 (1) 118-124
• 24 Panumatrassamee K, Kaouk JH, Autorino R , et al. Cryoablation versus minimally invasive partial nephrectomy for small renal masses in the solitary kidney: impact of approach on functional outcomes. J Urol 2013; 189 (3) 818-822
• 25 Turna B, Kaouk JH, Frota R , et al. Minimally invasive nephron sparing management for renal tumors in solitary kidneys. J Urol 2009; 182 (5) 2150-2157
• 26 Gill IS, Kamoi K, Aron M, Desai MM. 800 Laparoscopic partial nephrectomies: a single surgeon series. J Urol 2010; 183 (1) 34-41