Cancer Research Lab

In select cases, image-guided, percutaneous cryoablation is a safe and effective means of obliterating tumors in the kidney, according to a report this week at the 32nd Annual Scientific Meeting of the Society of Interventional Radiology in Seattle.

The percutaneous approach is also “much cheaper, has a much quicker recovery time and a much shorter hospital stay” compared with laparoscopic surgery, Dr. J. Louis Hinshaw, of University of Wisconsin in Madison, said.

Dr. Hinshaw presented data for 19 cases of renal cryoablation performed percutaneously and 48 performed laparoscopically. The average patient age was about 68 years in both groups.

“When we first started treating kidney tumors with cryoablation, we were doing them all laparoscopically,” the radiologist noted. “The surgeon would get the kidney exposed, and then we would do the cryoablation through the laparoscopic ports.”

They soon found that some cases did not require laparoscopy. Instead, they used ultrasound and CT to locate the tumor and guide the cryoablation probe.

However, “there has never been a study published that compared the two approaches,” Dr. Hinshaw said.

They found that the percutaneous approach was at least as safe and effective as the laparoscopic approach. Major complications occurred in 6.3% of cases treated laparoscopically, whereas there were none in the percutaneous group. Local recurrence rates were 12.5% versus 10.5%, respectively.

The hospital stay was significantly shorter in the percutaneous group, at 1.1 day versus 2.5 days, and the cost was 59.5% lower.

In some ways, it is difficult to compare the two procedures, the physician noted. The approach used “was made on a patient-by-patient basis in conjunction with the urologist.”

Much has to do with size and location of the tumor, he added. Interventional radiologists can treat tumors up to about 3 centimeters in size. The approach is also more likely to be used with sicker patients who have multiple comorbidities - those who can not tolerate surgery and general anesthesia.

Patients are more likely to be treated laparoscopically if their tumors are larger, centrally located, or in close proximity to the bowel or the ureter, Dr. Hinshaw said.

“Just as with all evolving and changing technology and therapies, it takes a while to accrue sufficient long-term data to say with certainty that (percutaneous cryoablation) is what we should be doing,” he concluded.