Retroperitoneal laparoscopic cryoablation of small renal tumors: intermediate results

doi:10.1016/S0090-4295(02)02004-6

Urology

Volume 61, Issue 1, January 2003, Pages 83-88

https://doi.org/10.1016/S0090-4295(02)02004-6 Get rights and content

Abstract

Objectives

To present our experience with laparoscopic renal cryoablation with up to 3 years of follow-up. Laparoscopic renal cryoablation remains a viable option for the treatment of small peripheral renal masses in patients with significant comorbidities. Although partial nephrectomy has been shown to be a safe and reliable method of renal parenchymal preservation, laparoscopic cryoablation still requires longer term data to prove its efficacy.

Methods

Twenty patients with small renal masses (1.4 to 4.5 cm) underwent laparoscopic renal cryosurgery at our institution. A retroperitoneal laparoscopic approach was used to expose the kidney. Intraoperative ultrasound guidance was used to localize the lesions and monitor iceball formation. A double-freeze technique was used. Needle biopsies of solid masses were performed intraoperatively.

Results

Renal biopsies revealed renal cell carcinoma in 11 of the 20 patients. Of these 11 patients, none had evidence of recurrent disease at last follow-up, and follow-up scans showed no enhancement of any lesions. Of the 8 patients with follow-up of 2 years or greater, 4 had complete resolution of the renal lesions. The remainder had lesions that were reduced and stable in size. Complications included surgical re-exploration to evaluate pancreatic injury in 1 patient and failure to ablate a lesion in another.

Conclusions

Laparoscopic renal cryoablation appears to be an effective tool for ablation of small renal lesions. A moderate length of follow-up continues to demonstrate efficacy because no patients had growth of treated pathologic lesions or developed metastasis to date. Continued maturation of data is necessary to determine the long-term efficacy.

Section snippets

Patients

Between October 1997 and January 2001, 20 patients underwent laparoscopic renal cryoablation (Table I). In all patients, preoperative computed tomography (CT) or magnetic resonance imaging (MRI) showed a solid or complex renal mass less than 4 cm in size. Patient age ranged from 40 to 84 years. Metastatic disease was not evident on any staging studies, including laboratory tests, chest radiography, CT, and/or MRI. All patients were thoroughly counseled regarding the procedures that were

Surgery

The results are summarized in Table II. All the procedures were accomplished laparoscopically by a retroperitoneal approach. Biopsies confirmed renal cell carcinoma in 11 patients, benign tubules in 3 patients, chronic pyelonephritis in 2 patients, oncocytoma in 1 patient, fibrosis in 1 patient, and were not done in 2 patients. All lesions were treated regardless of the biopsy result because all had been identified radiographically. The standard of care has been to treat all such renal masses

Comment

Although concerns of potential urethral and rectal damage limit the extent of freezing in prostate cryosurgery, peripheral renal lesions may be frozen completely with a margin of normal renal tissue, with little risk of complications in the remainder of the normal kidney. It is unknown whether central renal lesions can be treated successfully because of the heat sink of large renal vessels and the potential for urinary fistula and obstruction if the renal pelvis is frozen.14 Recent animal

Conclusions

Treatment of small renal tumors by a laparoscopic approach and cryosurgical ablation is possible with low morbidity. The loss of functioning renal parenchyma appears to be minimal. Intermediate-term follow-up with MRI showed successful destruction and involution of the lesions. Long-term follow-up of a larger number of patients will be critical to determine the efficacy as measured by local recurrence, metastatic control, and survival.

References (24)

M. Licht et al.
Nephron sparing surgery for renal cell carcinoma
J Urol
(1993)
F. Marshall et al.
The feasibility of surgical enucleation for renal cell carcinoma
J Urol
(1986)
I.S. Gill et al.
Laparoscopic renal cryoablation in 32 patients
Urology
(2000)
R. Miller et al.
Percutaneous transperineal cryosurgical ablation of the prostate for the primary treatment of clinical stage C adenocarcinoma of the prostate
Urology
(1994)
R. Stephenson et al.
Renal cryoablation in a canine model
Urology
(1996)
R. Rodriguez et al.
Renal ablative cryosurgery in selected patients with peripheral renal masses
Urology
(2000)
I.S. Gill et al.
Laparoscopic renal cryoablationinitial clinical series
Urology
(1998)
I.S. Gill et al.
Renal cryosurgery
Urology
(1999)
S. Chosy et al.
Monitoring renal cryosurgerypredictors of tissue necrosis in swine
J Urol
(1998)
S. Nakada et al.
Laparoscopic cryosurgery of the kidney in the porcine modelan acute histological study
Urology
(1998)

S. Campbell et al.

Renal cryosurgeryexperimental evaluation of treatment parameters

Urology

(1998)

R. Chen et al.

Laparoscopic cryoablation of renal masses

Urol Clin North Am

(2000)

Cited by (110)

Safety and Efficacy of Stereotactic Ablative Radiation Therapy for Renal Cell Cancer: 24-Month Results of the RSR1 Phase 1 Dose Escalation Study
2023, Practical Radiation Oncology
Stereotactic body radiation therapy (SBRT) has become a new therapeutic option for primary renal cell carcinoma. However, treatment doses lack consistency in the literature. The primary objective of this study was to determine the maximum tolerated dose for renal cancer SBRT.
This phase 1 multicentric dose-escalation study assessed 4 dose levels: 8 Gy × 4, 8 Gy × 5, 10 Gy × 4, and 12 Gy × 4. The primary objective of this study was to determine the maximal tolerated dose, defined by the occurrence of dose-limiting toxicity was defined as any acute side effect of grade ≥4 based on the Common Terminology Criteria for Averse Events, version 4.0.
From October 2010 to September 2017, 13 patients were enrolled. The median follow-up was 23 months. There was no dose-limiting toxicity in our study, and the highest dose was reached successfully. No acute or late toxic effects above grade 2 were seen. There was no significant alteration of renal function after treatment. At 24 months, 2 patients had partial response and the others had stable disease.
After 24 months of follow-up, no dose-limiting toxicity was seen at any of the prescribed dose levels in our study. The findings suggest that our last dose level of 48 Gy in 4 12-Gy fractions can be considered safe and can be used in further studies.
Laparoscopic cryoablation for clinical stage T1 renal masses: Long-term oncologic outcomes at the medical college of wisconsin
2014, Urology
To report the long-term oncologic outcomes of laparoscopic cryoablation for clinical stage T1 renal masses at the Medical College of Wisconsin.
A retrospective chart review was performed evaluating patients who underwent laparoscopic cryoablation for renal masses at the Medical College of Wisconsin between February 2000 and October 2009.
A total of 171 renal masses in 144 patients were treated by laparoscopic cryoablation during the study period. After excluding patients with <5 years follow-up and those with >clinical stage I disease, 112 renal masses treated in 92 patients remained for analysis. Mean patient age was 59.6 years (standard deviation [SD], 12.5 years). Mean lesion size was 2.3 cm (SD, 0.94 cm). Mean age adjusted Charlson comorbidity index was 4.55 (SD, 1.69). Mean follow-up was 97.9 months (SD, 24.8 months). Overall survival among all patients was 80.9%. Lesions were biopsy proven to be malignant in 70 patients (76.3%). Of those with biopsy-proven malignancy, there were 6 recurrences, 14 non–cancer-related deaths, and 1 cancer-related death, leading to an overall survival of 77.6%, progression-free survival of 91.0%, and cancer-specific survival of 98.5%.
We report the largest published series of laparoscopic renal cryoablation with the longest follow-up. Our series indicates that laparoscopic cryoablation is both an efficacious treatment for clinical stage T1 renal masses and provides excellent long-term oncologic outcomes.
Cryotherapy and its applications in the management of urologic malignancies: A review of its use in prostate and renal cancers
2014, Urologic Oncology: Seminars and Original Investigations
Cryotherapy has been established as an ablative modality for the treatment of a wide range of malignancies. Being minimally invasive, it is associated with less morbidity than conventional extirpative surgical procedures. In recent years, it has been used with success for treating two of the common urologic malignancies, that is, prostate and renal cancer. In this review, we highlight the role of cryotherapy as a treatment modality, the proposed destructive mechanisms of action and the risks of its use in the management of prostate and renal malignancy.
Probe ablation as salvage therapy for renal tumors in von Hippel-Lindau patients: The Cleveland Clinic experience with 3 years follow-up
2013, Urologic Oncology: Seminars and Original Investigations
To evaluate the efficacy and safety of probe ablative therapy as salvage treatment for renal tumor in von Hippel-Lindau (VHL) patients after previous partial nephrectomy (PN).
Medical records of VHL patients undergoing probe ablative treatment for renal tumors from March 2003 to January 2010 at our institution were retrospectively analyzed.
Fourteen VHL patients who were submitted to salvage probe ablative therapy were included in the analysis. Twelve patients (85%) had a solitary kidney. Overall, 33 tumors were ablated by either percutaneous cryoablation (P-Cryo) (n of procedures = 13), radiofrequency ablation (RFA) (n = 14), and laparoscopic cryoablation (L-Cryo) (n = 3). Average maximal renal tumor diameter was 2.6 ± 1 cm. Average ablation time was 18.3 ± 2.1 minutes for P-Cryo, 36.7 ± 17 minutes for RFA, and 17.3 ± 4 minutes for L-Cryo. All procedures were successfully completed without transfusions and intraoperative complications. No early postoperative complications were recorded. Postoperative decline in renal function was minimal and not clinically significant. With a mean follow-up of 37.6 months (range 12–82), 4 patients had a suspicious recurrence on computed tomogaphy/magnetic resonance imaging (CT/MRI) scan and in 3 of them a re-ablation was performed. Actuarial overall and cancer-specific survivals were 92% and 100%, respectively.
Probe ablative therapy seems to represent a suitable treatment option for VHL patients with a previous history of PN as it offers a repeatable operation, with a high technical success rate and causing minor changes in renal function.
Cryotherapy for renal tumors by a laparoscopic approach
2012, Progres en Urologie - FMC
La néphrectomie partielle est le traitement curateur de référence des petites tumeurs rénales, dont l’incidence est en constante augmentation, grâce notamment aux progrès de l’imagerie permettant la découverte fortuite de petites tumeurs chez des patients de plus en plus âgés et/ou présentant des co-morbidités. Des alternatives mini-invasives se sont développées (cryothérapie ou radiofréquence), traitements ablatifs validés qui peuvent être réalisés par voie laparoscopique ou par voie percutanée sous contrôle radiologique (scanner ou IRM). Cet article se propose de faire le point sur la cryothérapie par une approche laparoscopique, qui permet de traiter les tumeurs du rein avec une morbidité faible et des résultats oncologiques encourageants.
Partial nephrectomy is the gold standard in small renal cancer treatment, for which overall incidence is steadily rising, due to the progress in imaging techniques allow to discover small renal tumors incidentally in a population of patients more older and with several comorbidities. Minimally invasive techniques have developed (cryotherapy or radiofrequency ablation), ablative therapy now valided done by a laparoscopic or an image-guided percutaneous approach (with computed tomography or magnetic resonance). This article will make a review of cryotherapy done by a laparoscopic approach, which is a reliable therapeutic alternative for small renal tumors with low morbidity and reasonable middle-term oncological results.
Oncologic results of laparoscopic renal cryoablation for clinical T1a tumors: 8 years of experience in a single institution
2010, Urology
To review the oncologic outcomes of laparoscopic renal cryoablation (LRC) for small renal masses (SRMs) <4 cm.
The present study was an observational, retrospective analysis of LRC in 123 patients. The indications for LRC were solid SRMs of the kidney <4 cm in diameter diagnosed on preoperative computed tomography or magnetic resonance imaging as an enhancing mass. Follow-up was determined using magnetic resonance imaging. Local recurrence after LRC was defined as an enlarging or persistently enhancing treatment site on follow-up imaging.
A total of 131 SRMs in 123 patients (91 men and 32 women) were treated from September 2000 to June 2008. The mean tumor size was 2.14 ± 0.86 cm (range 0.5-4). Biopsy cores from the 123 patients revealed clear cell renal cell carcinoma (RCC) in 69 patients (56.1%), papillary RCC in 8 (6.53%), chromophobe RCC in 3 (2.4%), mucinous, tubular, and spindle RCC in 1 (0.8%), oncocytoma in 27 (21.9%), angiomyolipoma in 5 (4.1%), and xanthogranulomatous pyelonephritis in 1 patient (0.8%). The biopsy findings were nondiagnostic (fibrotic/necrotic tissue) in 9 cases (7.3%). The mean follow-up was 46.04 ± 25.75 months (median 41, range 12-96). In 44 patients with RCC and a mean follow-up of 61.3 ± 13.76 months, the cancer-specific survival rate was 100% and the overall survival rate was 93.2%. None of the 53 patients (RCC plus those with nonmalignant lesions) who had follow-up >5 years developed radiographic recurrence.
Our findings have confirmed that LRC can be considered a safe and intermediate-term effective method to treat SRMs.

View all citing articles on Scopus

View full text

Adult urologyRetroperitoneal laparoscopic cryoablation of small renal tumors: intermediate results

Abstract

Objectives

Methods

Results

Conclusions

Section snippets

Patients

Surgery

Comment

Conclusions

J Urol

J Urol

Urology

Urology

Urology

Urology

Urology

Urology

J Urol

Urology

Urology

Urol Clin North Am

Adult urology
Retroperitoneal laparoscopic cryoablation of small renal tumors: intermediate results