Cryosurgical Ablation of Renal Cell Carcinoma

BACKGROUND: Small renal masses are being commonly diagnosed incidentally in older patients. A partial nephrectomy is the first-line nephron sparing treatment option for these lesions. However, probe ablative therapy such as cryoablation is emerging as an alternative option for select patients requiring nephron sparing surgery. METHODS: The current literature regarding the management of small renal lesions with cryoablation was retrospectively reviewed. We selected six of the largest published series of renal cryoablation with a total of 320 patients. The diagnosis, staging, treatment options, mechanism, efficacy and morbidity associated with renal cryoablation were evaluated. RESULTS: Renal cryoablation for localized small renal masses is well tolerated and associated with a low complication rate. The range of mean tumor size in our literature review series (320 patients) was 2.3 to 2.6 cm. After a range of mean follow-up of 5.9 to 72 months, including a series with a minimum of 5 years of follow-up, the cancer specific survival was 97% to 100% and overall patient survival was 82% to 90.2%. CONCLUSIONS: Renal cryoablation, based on available clinical reports, appears to be a curative option for patients with small localized renal cell carcinomas (RCCs) who are unwilling or unable to undergo a partial nephrectomy. With encouraging intermediate oncological follow-up available, longer-term follow-up is needed to validate the use of cryoablation as a primary treatment option.