“There are distinct theoretical advantages and disadvantages to each strategy,” write Dr. Robert Uzzo, with the Fox Chase Cancer Center in Philadelphia, Pennsylvania, and colleagues.
For example, the surgical (predominantly laparoscopic) approach allows placement of cryotherapy probes into lesions under direct vision but the percutaneous approach uses imaging guidance. While the surgical procedure requires general anesthesia for the patient, percutaneous cryoablation can be performed on an outpatient basis under sedation or local anesthesia.
Most studies of cryoablation technique, whether surgical or percutaneous, have focused on procedural times, costs and lengths of stay, the authors explain. “Equivalence of efficacy between the two cryotherapy approaches has been presumed, but not definitively established,” they point out.
To remedy that, the authors performed a meta-analysis of 42 published series encompassing 1447 small renal masses, to compare surgical cryoablation (1062) and percutaneous cryoablation (375) in terms of oncological outcomes.
“The rate of residual tumour was not statistically different after surgical cryoablation (median, 0.033 recurrences per person-year, or 4.3%) and percutaneous cryoablation (median, 0.046 recurrences per person-year, or 5.3%; p=0.24),” Dr. Uzzo and colleagues report.
Similarly, the median rate of tumor recurrence was comparable with surgical or percutaneous cryoablation — 0.008 per person-year, or 1.4%, vs. 0.009 per person year, or 1.1%, respectively. There were two occurrences of metastasis in the surgical group and one in the percutaneous group.
“In conclusion, cryotherapy can be performed via either a percutaneous or a surgical (primarily laparoscopic) approach,” the authors write. “The analysis of treatment efficacy between the two approaches in the present study showed that neither regimen was superior to the other.”
Percutaneous vs surgical cryoablation of the small renal mass: is efficacy compromised?
BJU Int 2010