CIO 2021-27 Cryoablation in the Treatment of Renal Cell Carcinoma: A Review

Purpose: The focus of this educational exhibit is to present a concise review of the utility of percutaneous cryoablation (PCA) in the treatment of renal cell carcinoma (RCC).

Material and Methods: We present a review of PCA in the setting of RCC consisting of a concise literature review in both text and figure form detailing the supporting data, patient selection, technique.

Results: The proportion of patients diagnosed with stage I RCC is increasingly more common, owed mostly by incidental detection and better identifying high-risk patients. Given the early-stage disease, therapies designed to be nephron-sparing, such as PCA, are becoming increasingly important and as such, Prior to the procedure, a biphasic contrast-enhanced computed tomography (CT) or magnetic resonance imaging of the kidneys is reviewed and patients with lesions within 1 cm of the adrenal glands were premedicated with alpha- and beta-blockers for 5 days. Under moderate sedation and CT guidance, a biopsy may be performed before ablation. Interventinalists should aim to generate an ice ball that extends to 5 mm or greater beyond the tumor margin. If an adjacent structure is within the field, a fine needle is inserted between the structure and RCC to provide an air/hydrodissection. CA is performed with a 10-minute freeze, 8-minute thaw, and then a 10-minute refreeze. Following ablation, a noncontrast CT is obtained to evaluate for early complications. Data shows that patients receiving PCA have high 5- and 10-year overall survival, recurrence-free survival, disease-specific survival, and dialysis-free probability. Compared with partial (PN) and radical nephrectomy (RN), PCA has been associated with similar or better disease-specific survival and similar or lower long-term risk for starting hemodialysis. Data suggests that a major benefit of PCA versus laparoscopic or traditional surgery appears to be a reduced number of complications. PCA has been associated with flank pain, transient hematuria, perinephric hematoma, and rarely, arterio-venous fistula or colo-ureteral fistula.

Conclusions: PCA is becoming increasingly recognized as a safe and effective treatment for stage 1 RCC. Data suggests that PCA disease-specific survival and dialysis-free rates are similar or better than PN or RN.