Renal ablative therapy: Radiofrequency ablation and cryoablation

Raman, Jay D.; Hall, David W.; Cadeddu, Jeffrey A.

doi:10.1002/jso.21194

Cited by 23 publications

(6 citation statements)

References 54 publications

(65 reference statements)

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“…So far probe ablation with radiofrequency ablation (RFA) and cryoablation is increasingly being utilized as primary surgical therapy for small renal tumors (SRTs) [3]. Microwave ablation (MWA) has been widely used in China for hepatocellular carcinoma.…”

Section: Introductionmentioning

confidence: 99%

Microwave ablation versus partial nephrectomy for small renal tumors: Intermediate‐term results

Guan

Bai

Liu

et al. 2012

Journal of Surgical Oncology

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Section: Introductionmentioning

confidence: 99%

Microwave ablation versus partial nephrectomy for small renal tumors: Intermediate‐term results

Guan

Bai

Liu

et al. 2012

Journal of Surgical Oncology

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“…Though this application of cryoablation is novel, the use of cryoablation is well established and safe in humans [18][19][20][21][22]; commercial products are currently available and in use, making it easy to use without the need for creating new devices or equipment. Cryoablation creates intracellular ice crystallization that damages the endothelium and results in microcirculatory disruption [23]. In this application, the purpose of using cryoablation is not to destroy the renal mass but rather to create a plane of frozen tissue that would "seal in" the blood in the remaining wellperfused portion of the kidney.…”

Section: Discussionmentioning

confidence: 99%

Robotic-assisted laparoscopic cryo-partial nephrectomy: a novel technique using cryoablation in lieu of hilar clamping in a porcine model

et al. 2010

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Laparoscopic and robotic-assisted partial nephrectomy has become an increasingly viable approach for the resection of renal tumors. There are several technical limitations in performing laparoscopic partial nephrectomy, the most significant being the inability to easily obtain cold ischemia which allows for an extended operative time. In this study, we evaluated the feasibility and efficacy of cryoablation as an alternative to hilar clamping to maintain hemostasis during robotic-assisted laparoscopic partial nephrectomy in a porcine model. Twelve female swine underwent nine open and eight robotic-assisted laparoscopic partial nephrectomies using modified cryoablative methods to create hemostasis. Renal perfusion imaged with indocyanine green (ICG) and histological analysis was assessed immediately after the procedure and at 3 weeks post-operatively. With two freeze/thaw cycles, all nine open and eight robotic-assisted laparoscopic partial nephrectomies were successfully completed without the need for hilar clamping. The mean blood loss for the open and robotic-assisted groups was 230.6 and 99.4 ml, respectively. In all cases, maintenance of renal perfusion was confirmed by the presence of a renal pulse and intraoperative ICG imaging immediately and 3 weeks post-operatively. The histological anatomy was well preserved in the resected segment following cryo-resection. After 21 days following cryo-resection, histological analysis demonstrated normal viable tissue with minimal scarring in the remaining kidney. The use of cryoablation created a zone of hemostasis without compromising the vascularity of the remaining kidney, while preserving the renal cytoarchitecture of the segment remove for pathological analysis. Further studies will help to delineate its usefulness in laparoscopic partial nephrectomy.

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“…Surgical excision remains the reference standard for the curative treatment of small renal masses . Ablative therapy with either cryoablation or radiofrequency ablation (RFA) has been proposed as a minimally‐invasive, renal function‐preserving therapy in patients who may be poor candidates for surgery . One of the criticisms of published studies on ablative therapy is the lack of tissue‐based outcome data because most studies are based only on radiographical assessment .…”

Section: Introductionmentioning

confidence: 99%

Radiofrequency ablation of renal tumours with clinical, radiographical and pathological results

et al. 2013

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Objectives To evaluate our experience with radiofrequency ablation (RFA) for renal masses and to report on clinical, radiological and post-RFA biopsy results. Patients and methods The study collected clinical, radiological and pathological data from 150 consecutive patients who were treated with RFA of a renal mass between 2002 and 2008 at a tertiary referral centre. Post-ablation biopsies were performed in patients with non-involuting lesions or suspicion of recurrence on imaging. Comparisons were performed using the Mann–Whitney U-test. Survival was estimated using the Kaplan–Meier method. Results Renal malignancy was found in 72.1% of patients based on the initial diagnostic biopsy. Median tumour size was 2.6 cm, 22.7% of patients had a solitary kidney, and most were central tumours. The mean follow-up period was 40.1 months. There was no recurrence in 96.7% of the entire cohort. Cancer-specific survival for 106 patients with sporadic, localized, biopsy proven renal malignancy was 100% at 38.5 months. Biopsies were obtained in 43 patients for a median of 21 months after RFA. Among 38 patients who had biopsy for non-involuting, non-enhancing zones of ablation, three (7.9%) were positive. Conclusions Short-term cancer-specific survival after RFA remains excellent and most cases are successful based on a combination of imaging and post-ablation biopsies performed almost 2 years after treatment. There were four out of 150 (2.7%) patients who had recurrences with tissue confirmation; one of these patients was detected on imaging and three (2%) were radiologically occult. The absence of enhancement in the setting of non-involuting lesions is not always a guarantee of a successful ablation.

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Renal ablative therapy: Radiofrequency ablation and cryoablation

Cited by 23 publications

References 54 publications

Microwave ablation versus partial nephrectomy for small renal tumors: Intermediate‐term results

Microwave ablation versus partial nephrectomy for small renal tumors: Intermediate‐term results

Robotic-assisted laparoscopic cryo-partial nephrectomy: a novel technique using cryoablation in lieu of hilar clamping in a porcine model

Radiofrequency ablation of renal tumours with clinical, radiographical and pathological results

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