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A Gentler Approach to Kidney Cancer, Percutaneous Cryoablation

New York (Apr 15, 2009)

Surgical removal of the kidney has long been a standard treatment for kidney cancers. Today NewYork-Presbyterian Hospital clinicians are able to use minimally invasive treatments to freeze some small kidney cancers without even making an incision by using a new procedure called "percutaneous cryoablation."

What is Percutaneous Cryoablation?

The freezing of tumors – a therapy which has been used to treat certain lung, liver, and prostate cancers – is also particularly well suited for certain kidney cancers called renal cell carcinomas. Relying on computed tomography, magnetic resonance imaging (MRI), or ultrasound guidance, a urologist and an interventional radiologist work together to insert several 1.5 mm "ablation" needles through the patient's skin into the kidney tumor. Once the needles are in place, the device called a "cryoablation machine" delivers temperatures of -140 degrees C or lower until the entire tumor and surrounding borders are frozen.

The surgeon and radiologist initiate several freeze/thaw cycles until they are confident that the tumor cells have been killed. "The CT scanner can be used to actively monitor the development of the ablative iceball to precisely control the destruction of the tumor," explained Jaime Landman, MD. The procedure typically takes just 45 minutes and can be done without general anesthesia.

Over time, the tumor tissue "scars down" and eventually disappears. "The truly revolutionary aspect of this treatment is the realization that we don't have to surgically cut out cancer tissue, which shatters a thousand years of medical and surgical tradition," Dr. Landman added.

Benefits of Percutaneous Cryoablation

Percutaneous ablation offers several benefits. The patient receives only mild sedation and a local numbing anesthetic where the needles are inserted, so there is no risk of side effects from general anesthesia. No urinary catheter is required. The surgeon does not have to clamp the renal artery (the vessel which supplies blood to the kidney) to temporarily cut off the blood supply, leaving kidney function intact. Usually no more than an overnight hospital stay is required, and patients can return to their normal activities sooner than they would following conventional surgery or even other forms of minimally invasive surgery.

Canidates for Percutaneous Cryoablation

But not everyone is a candidate for percutaneous cryoablation. A number of factors help determine patient eligibility including age, tumor size, and tumor location within the kidney. According to Joseph Del Pizzo, MD, the procedure is best suited for older patients with masses on the back of the kidney less than 3 cm in diameter that are not located too close to the the main blood supply or urine-producing cells of the kidney.

"We are just starting to receive long-term outcomes data on patients who've had this procedure, so I don't usually recommend it for patients who may still have 25 or 30 years of life ahead of them," he noted. Younger patients, those with larger tumors, and those with tumors close to vital structures may be best served by laparoscopy (minimally invasive surgery) or open abdominal surgery, as indicated. All options are available at NewYork-Presbyterian Hospital.

"During percutaneous ablation, we move body structures around like we do during open or laparoscopic surgery," added Dr. Landman. "If the tumor isn't near an important anatomic structure, we can freeze it and not harm anything. Cryoablation is a remarkably kind and gentle therapy."

Some patients have small renal masses that are not located in the best position for percutaneous cryoablation. These patients may be eligible for "laparoscopic-assisted" cryoablation, which utilizes the same principles as the percutaneous approach, but requires laparoscopic access to mobilize structures around the kidney before cryoablation.

Future of Percutaneous Cryoablation

"I think the next generation of doctors will be doing more ablative technologies," said Dr. Del Pizzo. "We're seeing more and more patients whose renal tumors are being detected early when they are having computed tomography (CT or CAT) scans for something else. Many of these patients are elderly and they may be candidates for these less invasive procedures."

"Percutaneous cryoablation is made possible by the marriage of two different technologies, imaging and cryoablation – neither of which is brand new," concluded Dr. Landman. "But by combining them, we can do a minimally invasive procedure in a way we've never done before."

Percutaneous Cryoablation at Two Locations

Percutaneous cryoablation for kidney cancer is offered at both the Columbia University Medical Center and Weill Cornell Medical Center campuses of NewYork-Presbyterian Hospital.

You can view a video of percutaneous cryoablation.

Faculty Contributing to this Article:

Jaime Landman, MD is Director of Minimally Invasive Urology at NewYork-Presbyterian Hospital/Columbia University Medical Center, and an Associate Professor of Surgery at Columbia University College of Physicians and Surgeons.

Joseph Del Pizzo, MD is Director of Minimally Invasive Surgery at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, and an Associate Professor of Urology at Weill Cornell Medical College.

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