Cryo Techniques Give Similar Results

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SEATTLE—Percutaneous cryoablation as a treatment for renal cell carcinoma (RCC) is as safe and effective as laparoscopic cryoablation in appropriate candidates, researchers reported here at the annual meeting of the Society for Interventional Radiology.

"The percutaneous approach, however, is associated with a slightly lower tumor recurrence rate and shorter hospital stay. This early-stage research indicates that percutaneous cryoablation in the appropriate patient population can effectively kill tumors, while also offering patients a shorter hospital stay, a faster recovery, and an excellent safety profile, all at a lower cost than laparoscopy," said study investigator J. Louis Hinshaw, MD, assistant professor of radiology at the University of Wisconsin in Madison.

"Unfortunately, not all patients are viable candidates for percutaneous ablation, and we work closely with our urology colleagues to ensure that each patient receives the most appropriate treatment."

The investigators performed 19 percutaneous renal cryoablations with CT and ultrasound guidance and compared the outcomes to those of 48 patients treated with laparoscopic renal cryoablation. The percutaneous group had a mean age of 68.6 years and a mean follow-up of 7.3 months.

The laparoscopic group had a mean age of 68.2 years and a mean follow- up of 13.3 months. Dr. Hinshaw's team selected patients for one approach or the other based on tumor location (posterior and exophytic favored percutaneous), proxim- ity to the bowel, and patient comorbidities. All the procedures were performed under general anesthesia and the percutaneous patients were pre-planned to stay in the hospital over-night.

Post-ablation results were monitored every three months with contrast-enhanced MRI. Investigators used CT to monitor patients if they could not undergo MRI for medical reasons. The tumor recurrence rate was 10.5% in the percutaneous group and 12.5% in the laparoscopic group, Dr. Hinshaw and his group reported. Patients treated with percutaneous cryoablation required fewer days in the hospital (1.1 vs. 2.5) and had no complications, compared with 6% in the laparoscopic group.

The percutaneous technique was 59.5% less costly ($14,154 vs. $22,557). "We are excited about this study because [percutaneous cryoablation] offers patients with renal cell carcinoma a less traumatic treatment that can be repeated as needed," Dr. Hinshaw related. "Depending on the stage of the disease, this procedure can be curative, but can also be used for palliative treatment in some settings." Major complications in the laparoscopic group included postoperative respiratory distress, intraoperative bowel injury repaired laparoscopically, and atrial fibrillation.

Dr. Hinshaw noted that these new findings are of particular importance because there are an estimated 30,000 new cases of RCC diagnosed annually in the United States, a fourfold increase from 1987. This increased incidence is believed to be largely due to incidental findings on CT scans or ultrasound examinations.

"This is the first study to compare the two procedures at the same institution," said Dr. Hinshaw, adding that the study was relatively large study and had good follow-up. "A lot of patients would be eligible for the percutaneous technique and it is easier on the patient and yet has equal efficacy with lower costs."

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