Renal Cryotherapy
Renal Cryosurgery has gained considerable
interest and popularity in renal cancer in recent years. During
this process, ultrathin needles are inserted into a renal tumour
and subjected to very low temperatures thereby destroying cancer
cells. The procedure was first performed in the UK by Mr
Christopher Anderson of St Georges hospital in December 2004. He
remains a leading contributor to this field of expertise and has
a large UK series to date.
Cryosurgery causes tissue destruction by
both immediate and delayed mechanisms. The freezing process
causes ice crystals to form in the space outside the cells and in
small blood vessels. This leads to destruction of the cells
themselves. During the thaw phase further cellular
destruction occurs.
The third generation of probes (Galil) that
have been developed for this purpose are ultra thin making
insertion into the desired target areas relatively easy. An
ice ball forms around approximately 9mm radius at the tip of the
probes and by spacing the probes at appropriate intervals a large
ice ball can be created by the confluence of individual overlapping
ice balls.
In the context of renal cancer cryosurgery
is done mostly by keyhole surgery (laparoscopy). Incidentally, 40%
of small renal tumours are discovered incidentally when scanning
for other reasons. The standard treatment has traditionally
been partial removal of the kidney but cryosurgery is emerging as a
strong contender in the management of these smaller tumours due to
its considerably less invasive nature.
Some clinical scenarios where cryosurgery
might typically be applicable is the elderly patient who presents
with a small kidney lesion; patients with other medical
problems (perhaps impaired renal function) making the removal
of large segments of kidney tissue hazardous; in hereditary
renal cell cancers (Von Hippel Lindau Disease) or in people in whom
the tumours develop in multiple sites. The problem in the
hereditary forms is that the cancers can develop at a fairly young
age resulting in the possibility of these tumours recurring and
therefore requiring repeat attempts at surgical intervention.
Although long term follow up is not yet
available there certainly is encouraging data that this is an
effective form of cancer ablation. A recent review in the
British journal of Urology (Dec 2005) has compared the minimally
invasive options for renal cancer management in the world
literature. There are a combined total of 326 reported cases with
a median follow up of 30.8 months. The disease recurrence
rate is 4.6% and complication rate is 10%. It is significant to
note that the procedure is safe and is associated with minimal
complications. No worsening of renal function has been found
in all the studies. Bleeding and urinary leaks are minimal in
cryosurgery.
The patient enjoys the benefits of minimally
invasive surgery with excellent cancer cure rates equivalent to
other forms of management for small renal cancers. The hospital
stay is usually only 2 days and there is no blood transfusion and
minimal pain relief required. Overall recovery is rapid with early
return to normal activity.
Information provided by Mr Christopher Anderson MB ChB
FSC(Urol)SA, Consultant Urologist
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