Probe ablative treatment for small renal masses: cryoablation vs. radio frequency ablation.
OBJECTIVE
Localized renal cell carcinoma has an excellent 5-year survival when treated surgically. Apart from extirpative treatment, ablative techniques are becoming more popular to minimize patient morbidity. Clinically, radio frequency ablation and cryoablation can be performed percutaneously or laparoscopically. Oncological effectiveness of ablative techniques is encouraging as 3-year data are emerging. Our review highlights the current literature demonstrating the effectiveness of cryoablation and radio frequency ablation performed laparoscopically or percutaneously.


RESULTS
Cryoablation performed laparoscopically or percutaneously offers excellent oncological outcomes with single-session therapy. With 3-year cancer-specific survival of 98%, laparoscopic cryoablation is safe and can be performed with minimal insult to overall renal function. Local recurrence rates and metastatic progression also seem to favor cryoablation over radio frequency ablation (4.6 vs. 11.7% and 1.2 vs. 2.3%, respectively). Radio frequency ablation also offers similar survival rates; however, re-treatment rates are higher (8.8%). Radio frequency ablation also carries a higher rate of collecting system injuries when performed percutaneously.


CONCLUSIONS
Cryoablation and radio frequency ablation are effective treatment modalities for small renal masses in the infirm patient. Given patient and technical variability, superiority of either radio frequency ablation or cryoablation cannot be confirmed based on available literature. However, there is a trend towards higher recurrence and re-treatment rates after radio frequency ablation.
Goel
Raj K
RK
Section of Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute Cleveland Clinic, Cleveland, Ohio 44195, USA.
Kaouk
Jihad H
JH
D002292:Carcinoma, Renal Cell / Q000601:surgery*; D017115:Catheter Ablation; D003452:Cryosurgery; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*