Kidney cancer: energy ablation.
OBJECTIVE
Solid renal tumours with a diameter 4 cm or less are frequently found during routine radiologic investigations. Since a significant number of patients are elderly and frail, there is a growing interest in effectively treating these patients by minimally invasive energy-ablative surgery.


RESULTS
Such tumours may be treated by either freezing (cryoablation) or by heat (radio-frequency ablation or high-intensity focused ultrasound). In addition, percutaneous methods are available, but percutaneous focused ultrasound is not feasible as yet with the technique available. All percutaneous techniques lack effective monitoring of ablation, however, and oncological follow-up commonly relies on radiologic measurements only. Not surprisingly, the effectiveness of all percutaneous procedures is significantly lower, with a high recurrence and re-treatment rate as compared with open or laparoscopic procedures. Long-term results in larger series are missing, but it seems that laparoscopic cryoablation is most effective in respect to oncological results, but requires more technical efforts and surgical skills as compared with radio-frequency ablation or focused ultrasound.


CONCLUSIONS
There is currently no ideal energy-ablative energy source on the horizon, but cryoablation seems to produce the most durable result. Focused ultrasound, however, may have the greatest potential for further developments.
Klingler
H Christoph
HC
Department of Urology, Medical University of Vienna, Austria. christoph.klingler@meduniwien.ac.at
D017115:Catheter Ablation; D003131:Combined Modality Therapy; D003452:Cryosurgery; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D010535:Laparoscopy; D016343:Monitoring, Intraoperative; D009367:Neoplasm Staging; D009392:Nephrectomy; D016896:Treatment Outcome; D014464:Ultrasonic Therapy