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Cryotherapy: clinical end points and their experimental foundations.
Jihad H Kaouk1, Monish Aron, John C Rewcastle
1Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. kaoukj@ccf.org
Urology
|July 22, 2006
Summary
Renal tumor cryotherapy is an effective, minimally invasive treatment for small tumors, showing high cancer-specific survival rates. Further long-term studies are needed to confirm efficacy compared to partial nephrectomy.
Area of Science:
- Urology
- Oncology
- Nephrology
Background:
- Increasing detection of early-stage renal tumors.
- Shift towards nephron-sparing treatments like ablation over radical nephrectomy.
- Cryotherapy is the most studied ablation technique with longest outcomes.
Purpose of the Study:
- To review the experimental and clinical evolution of cryotherapy for small renal masses.
- To examine current principles, techniques, and outcomes of renal tumor cryoablation.
Main Methods:
- Literature search using keywords: cryobiology, cryotherapy, cryoablation, renal function, etc.
- Review of experimental and clinical articles on cryoablation principles and techniques.
- Inclusion of recent studies on current clinical outcomes.
Main Results:
- Cryotherapy is feasible via open, laparoscopic, or percutaneous approaches.
- Cryotherapy does not adversely affect renal function or blood pressure; urinary leakage is rare.
- Reported 3-year cancer-specific survival is 98% for sporadic unilateral renal tumors.
Conclusions:
- Renal tumor cryotherapy has progressed beyond the experimental stage with encouraging initial outcomes.
- Lack of histologic confirmation of ablation is a major criticism.
- Long-term studies comparing cryotherapy to partial nephrectomy are necessary to confirm lasting efficacy.