Cryoablation for Small Renal Masses: Selection Criteria, Complications, and Functional and Oncologic Results

Zargar, Homayoun; Atwell, Thomas D.; Cadeddu, Jeffrey A.; Rosette, Jean J. de la; Janetschek, G.; Kaouk, Jihad; Matin, Surena F.; Polascik, Thomas J.; Zargar‐Shoshtari, Kamran; Thompson, R. Houston

doi:10.1016/j.eururo.2015.03.027

Cited by 112 publications

(92 citation statements)

References 87 publications

(165 reference statements)

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“…There appears to be no detrimental loss of renal function even in patients with a single kidney in patients who had cryotherapy by laparoscopic technique [33] or by imaging-guided percutaneous treatment [32]. This point was also reiterated by the systematic review by Zarga et al [10].…”

Section: Renal Function Preservationmentioning

confidence: 99%

“…Recently, Zargar et al performed a systematic review of cryotherapy of small renal masses and concluded that cryoablation had excellent functional outcome and low rate of complications. However, they suggested that patient selection criteria and oncological outcomes needed further study [10]. EuRECA is collecting prospective data from across Europe and will be able to throw more light in the coming years.…”

Section: Oncological Outcomementioning

confidence: 99%

“…The procedure, however, still has a learning curve and warm ischemia time to cope with making it difficult in patients with comorbidities [9]. Ablative therapy provides a less-invasive treatment option in this group of patients with reasonable oncological control comparable to partial nephrectomy [10].…”

Section: Introductionmentioning

confidence: 99%

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Non-Surgical Ablative Therapy for Management of Small Renal Masses—Current Status and Future Trends

Farrag

Sriprasad

2016

Indian J Surg Oncol

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A large number of small renal masses (SRMs) with size less than 4 cm are being identified due to advances in diagnostic imaging. As the natural history of these tumours remains unknown, there is no reliable way to predict their behaviour or future growth. Although, partial nephrectomy is the gold standard for treatment of these tumours, ablative non-surgical therapies such as cryoablation and radiofrequency ablation provide a less invasive option of treatment with comparable oncological outcomes. In this systematic review, the principle, indications, methods of treatment, oncological control, complication and renal function of ablative therapies are critically reviewed. Cryotherapy utilizes the principle of inducing tissue destruction by freezing and thawing using argon and helium gasses, respectively. Radiofrequency ablation (RFA) works on the principle of tissue heating. Ablative treatments are particularly useful in the elderly patients, those with comorbidities or in patients with SRMs in solitary kidneys or renal impairment. Ablative therapies have less procedurerelated complications and have promising medium-term oncological outcome. Longer-term results are accumulating. Cryotherapy may be a better modality for oncological control than RFA. Ablative therapy has emerged as a viable treatment options for SRMs with recurrence free survival rates approaching that of extirpative surgery. However, there is no consensus in the literature on the best selection criteria and this needs further refinement. Prospective long-term data with regards to oncological control is still needed

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Section: Renal Function Preservationmentioning

confidence: 99%

Section: Oncological Outcomementioning

confidence: 99%

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Non-Surgical Ablative Therapy for Management of Small Renal Masses—Current Status and Future Trends

Farrag

Sriprasad

2016

Indian J Surg Oncol

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“…An American Society of Anesthesiologists (ASA) score of 3 was associated with an increased risk of overall complications (odds ratio 2.85, 95% confidence interval 1.32-6.20; P = 0.005) [24]. Zargar et al [10] recently performed a systematic review of cryotherapy of small renal masses and concluded thatcryoablation had excellent functional outcome and low rate of complications. However, they recommended that patient selection criteria and oncological outcomes needed further evaluation.…”

Section: Oncological Outcome After Cryoablationmentioning

confidence: 99%

“…Ablative therapy, on the other hand, provides a less invasive treatment option in this group of patients with reasonable oncological control comparable to partial nephrectomy [10]. Cryoablation and Radiofrequency Ablation (RFA) are the two most popular ablative therapy techniques, currently.…”

Section: Introductionmentioning

confidence: 99%

Ablative Therapy in 2016 for Small Renal Masses

Ian¹,

Farrag²,

Sriprasad³

2017

UNOAJ

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Introduction: Incidental diagnosis of small renal masses (SRMs), less than 4 cm in size, is increasing due to the widespread use of different forms of diagnostic imaging. The natural history of these tumours remains unknown and there is no reliable way to predict their behaviour or growth. Partial nephrectomy is currently the gold standard in the treatment of these tumours. However, the more minimally invasive, non-excisional, ablative therapies such as cryoablation (CRA) and radiofrequency ablation (RFA) are providing comparable oncological outcomes.Methods: This article critically reviews the principles, indications, modalities of treatment, oncological outcome, complication and effect on renal function, of the different ablative therapies.Results: Cryotherapy induces tissue ablation by freezing and thawing using argon and helium gases respectively.RFA ablates the tissue by heating. These Ablative treatments for SRMs are particularly indicated in the elderly patients, those with co-morbidities, in patients with solitary kidneys and in those with impaired renal function. The procedure related complication rate with ablative therapies are lower. These procedures have a promising medium term oncological outcome, while longer-term results are awaited. It appears that Cryotherapy may be evolving as a better modality for oncological control than RFA. Conclusion:The Ablative therapies for SRMs are emerging as viable treatment options with recurrence free survival rates approaching that of extirpative surgery. However, there is currently no consensus in the literature on the best selection criteria for this form of treatment. With further refinement of selection criteria and more prospective long-term data on the oncological outcome, these ablative methods would have a promising future in the management of SRMs.

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Cryoablation inhibits the recurrence and progression of bladder cancer by enhancing tumour‐specific immunity

Mou

Zhang

Chen

et al. 2023

Clinical & Translational Med

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Background Recurrence and metastasis of bladder cancer are major factors affecting patient prognosis. Endoscopic cryoablation achieved a better clinical outcome among clinical patients and could be synergistic with ICIs. Thus, this study aimed to evaluate the immunological mechanism of cryoablation for bladder cancer to reveal the therapeutic mechanism. Methods We systematically reviewed the clinical prognosis of patients underwent cryoablation at Huashan Hospital in these first‐in‐human studies (ChiCTR‐INR‐17013060). Murine models were constructed to explore cryoablation‐induced tumour‐specific immunity, which was further confirmed by primary bladder tumour organoids and autologous lymphocytes cocultured system. Results Cryoablation improved progression‐free survival and recurrence‐free survival respectively. Assessment of murine models after cryoablation confirmed microenvironment remodelling and tumour‐specific T cells expansion. Enhanced antitumour effects were found after coculture of organoids with autologous lymphocytes collected from post‐cryoablation. We also demonstrated cryoablation‐induced tumour elimination required IFNGR expression on tumour cells. In addition, a long‐lasting antitumour memory response is achieved by cryoablation and could be enhanced after combination with ICIs. Conclusions This study revealed endoscopic cryoablation is an efficient and safe therapy for bladder tumour treatment. The tumour‐specific immune responses induced by cryoablation could reduce tumour recurrence and metastasis.

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Cryoablation for Small Renal Masses: Selection Criteria, Complications, and Functional and Oncologic Results

Cited by 112 publications

References 87 publications

Non-Surgical Ablative Therapy for Management of Small Renal Masses—Current Status and Future Trends

Non-Surgical Ablative Therapy for Management of Small Renal Masses—Current Status and Future Trends

Ablative Therapy in 2016 for Small Renal Masses

Cryoablation inhibits the recurrence and progression of bladder cancer by enhancing tumour‐specific immunity

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