Renal Cryoablation

1
RenalCryoablation
2
Renal Cryoablation

• Morbidity
• Efficacy
• Cancer Free Survival (NED)
• Cancer Specific Survival
• Post renal cryoablation metastases

3
Morbidity

• Deane and Clayman review (2006)
• n 320, Major complications lt 1
• Johnson et al (2004) multicenter of 139
  patients
• Major n 2 (1 )
• Significant hemorrhage n1
• Conversion from laparoscopic to open n1
• Minor n 17 (12 )
• Transient probe site pain n10
• Post-op UTI n2
• Post-op pneumonia infection n2
• Minor hemorrhage n1
• Wound infection n1
• Respiratory difficulty n1

Deane LA Clayman RC, Urology 2006 68 (Suppl
1A) 26-37 Johnson et al J Urology 2004 172 pp
874-877
4
Efficacy

• Cancer free survival
• (no pathologic evidence of disease)
• Cancer specific survival
• (RCC specific)
• Post cryoablation metastases

5
Cancer Free Survival Following Renal Cryoablation
97.55
96.63
96.41
100
952
954
93.36
80
60
Percent
40
20
0
3-years
4-years
5-years
1. Gill et al, J Urol. 2005 Jun173(6)1903-7 2.
Harmon et al (Rukstalis), Presented at the 2004
AUA 3. Begun et al, Journal of Urology 2006 175
1225-1229 4. Hasan et al (Gill), Presented at
the 2004 AUA 5. Davol et al (Rukstalis), Urology
2006 68 (Suppl 1A) 2-6 6. Hegarty et al (Gill),
Presented at the 2006 AUA After one or more
procedures 12.5 of patients required two
procedures
6
Cancer Specific Survival Following Renal
Cryoablation
1004
1002
1003
1005
1006
981
100
80
60
Percent
40
20
0
3-years
4-years
5-years
1. Gill et al, J Urol. 2005 Jun173(6)1903-7 2.
Harmon et al (Rukstalis), Presented at the 2004
AUA 3. Begun et al, Journal of Urology 2006 175
1225-1229 4. Hasan et al (Gill), Presented at
the 2004 AUA 5. Davol et al (Rukstalis), Urology
2006 68 (Suppl 1A) 2-6 6. Hegarty et al (Gill),
Presented at the 2006 AUA
7
Comparison of Partial Nephrectomy and
Cryoablation
References For Partial Nephrectomy All
studies quoted in Campbells Urology Table 75-15
Results of nephron Sparing surgery for renal
cell carcinoma Study Sizes 10 485 patients,
Mean follow-up 24 75 months For Cryoablation

8
Cryo vs. Partial Nephrectomy Cancer Specific
Survival
100
80
60
Percent
40
20
0
Partial Nephrectomy
Cryoablation
1. Andrew C. Novick and Steven C. Campbell.
Renal Tumors. In Campbells Urology 8th Edition
2. Nicholas J. Hegarty, et al. 2006 Jul68(1
Suppl)7-13. 3. Patrick E. Davol, et al. Urology.
2006 Jul68(1 Suppl)2-6. 4. Lawatsch EJ, et al.
J Urol. 2006 Apr175(4)1225-9. 5. Nicholas J
Hegarty, et al. Presented at the 2006 Annual
Meeting of the American Urological Association,
May 20-25, 2006, Atlanta Georgia 6. Gill IS, et
al. J Urol. 2005 Jun173(6)1903-7.
9
Cryo vs. Partial Nephrectomy Local Recurrence
Rate
10
8
6
Percent
4
2
0
Partial Nephrectomy
Cryoablation
1. Andrew C. Novick and Steven C. Campbell.
Renal Tumors. In Campbells Urology 8th Edition
2. Nicholas J. Hegarty, et al. 2006 Jul68(1
Suppl)7-13. 3. Patrick E. Davol, et al. Urology.
2006 Jul68(1 Suppl)2-6. 4. Lawatsch EJ, et al.
J Urol. 2006 Apr175(4)1225-9. 5. Nicholas J
Hegarty, et al. Presented at the 2006 Annual
Meeting of the American Urological Association,
May 20-25, 2006, Atlanta Georgia 6. Gill IS, et
al. J Urol. 2005 Jun173(6)1903-7.
10
Metastases following renal cryoablation

• Table III of Deane and Clayman (2006) reviews all
  publications of renal cryoablation
• Of 320 patients treated with cryoablation alone
  there exists not a single report of the
  development of post renal cryoablation metastases
• Immune response? Research is ongoing.
• Note Gill had four patients die of metastatic
  RCC but they all had bilateral disease and prior
  to cryoablation had all undergone partial or
  radical nephrectomy

Deane LA Clayman RC, Urology 2006 68 (Suppl
1A) 26-37 Gill et al, J Urol. 2005
Jun173(6)1903-7