Renal cryotherapy: 2003 clinical status

Traditionally, curative therapy for most renal cancers involved open radical nephrectomy. However, as increased radiological monitoring has led to more incidentally discovered small renal masses, the optimal treatment has evolved. Nephron-sparing surgery, initially developed for patients with solitary kidneys or compromised renal function, emerged as the treatment of choice for small renal masses. It has been shown that long-term cancer control and renal function after partial nephrectomy equals the results of radical nephrectomy. Cryoablation of small renal masses represents an alternative method for performing nephron-sparing surgery.

Cryoablation of renal tumors with ultrasound monitoring may be performed under open exposure, but laparoscopy provides equivalent exposure with less morbidity. Cryotherapy may also be performed percutaneously with magnetic resonance image monitoring. After treatment, patients require diligent radiographic monitoring, more frequently than after surgical extirpation.

The durability of renal cryotherapy appears promising. More data are required to provide reliable treatment of tumor margins for larger lesions, and further to determine the safety of use near the collecting system and renal hilum. Currently, cryoablation of small renal lesions is minimally invasive, safe, and efficacious for select peripheral lesions in carefully selected patients.