Kidney cancer ablative therapy: indications and patient selection

The increased application of radiographic imaging has paralleled a simultaneous increase in the detection of incidental and asymptomatic renal neoplasms. The reference standard for treating small renal tumors includes open and laparoscopic partial nephrectomy. The primary objectives of ablative renal procedures are to duplicate the excellent oncologic outcomes of partial nephrectomy while decreasing patient morbidity and shortening hospitalization and overall convalescence. Ablation, with cryotherapy or radiofrequency probes, offers the advantages of minimally invasive surgery, but with a significantly lower complication rate than laparoscopic partial nephrectomy. Ablation now represents a major change in surgical thinking as tumors are ablated and left in situ. This article reviews the status of the two ablative modalities currently available for clinical application, cryoablation and radiofrequency ablation.