Last Modified: November 1, 2001
Last Updated: 2001-02-20 18:00:38 EST (Reuters Health) - Open renal cryoablation can be safely used to destroy small solid renal masses, according to a report by Pennsylvania researchers.
Though small renal masses commonly represent localized disease, radical nephrectomy remains the standard therapy, the investigators report in the January issue of Urology. Less extensive techniques, were they safe and effective, could offer a better outcome by preserving the remaining renal mass and function.
Dr. Daniel Rukstalis, from MCP Hahnemann University, in Philadelphia, and colleagues report their phase I/II results from open renal cryoablation in 29 patients with small (below 4 cm) solid or indeterminate renal masses.
Only five serious adverse events were encountered during 29 operations. While three patients ultimately required dialysis, the need for dialysis was unrelated to the procedure, the authors report.
Estimated blood loss was minimal, with only two patients requiring a blood transfusion during or after cryoablation, the researchers note, and median hospital stay was only 3 days.
MRI performed 2 days after cryoablation in 12 patients showed infarcted lesions with minimal or no enhancement in 10 cases, the report indicates. Twenty of 23 patients showed complete resolution of their treated masses on MRI performed 3 months postcryoablation, and one additional patient had a persistent, small, nonenhancing, cystic lesion.
"Cryoablation requires only a 2-hour operation (standard partial nephrectomy takes as long as 2 to 4 hours), without a need for blood transfusions or intensive care unit costs," Dr. Rukstalis told Reuters Health. "The patient is most often discharged home after 23 hours to 2 days rather than 4 to 7 days after the open partial nephrectomy. Although we have not calculated specific dollar amounts, it is apparent that renal cryoablation is much less costly (by at least 50% to 60%) than traditional approaches."
"Renal cancer is being identified more often as a small incidental mass on the kidney in today's medical approach and, as such, most people have no symptoms. It is no longer necessary to remove an entire kidney or risk serious side effects to eradicate these small cancers," Dr. Rukstalis said.
Patients with renal masses smaller than 5 cm are excellent candidates for cryoablation if they are medically capable of undergoing a surgical procedure, he added. The only poor candidates are "individuals with very large cancers (>7 cm), evidence of spread of the cancer beyond the kidney, or severe medical illness."