Partial Nephrectomy vs Cryo-Ablation

Partial Nephrectomy vs Ablation Therapy

Upon their introduction, Ablation Technologies held great promise to easily treat Tumors through minimally invasive approaches.  Unfortunately, Patient Complication Rates and Cancer Recurrence Rates have been found to be quite high for Kidney Cancer.  As a result, the AUA and EAU recommend reserving their use for patients that are too sick, elderly, or whose prognosis to survive surgery is low.  

Ablation therapies employ the concept of "Thermal Spread," meaning that, whether cold or hot, the instrument applies energy to a target area to either freeze or burn any tissue within that area.  Naturally, it is extremely difficult to control exactly where and how far the Thermal Spread permeates.  Therefore, both Cryo-Ablation and RF Thermal Ablation destroy all tissue within close proximity of their instrument, including good, healthy tissue of the Kidney and that of any surrounding organs.  For these reasons, Cryo-Ablation and RF Thermal Ablation are increasingly being associated with higher Cancer Recurrence Rates and higher Patient Complication Rates than Partial Nephrectomy.[29]

Cancer Recurrence Rates by Modality

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Sources: See References 6-29

Guidelines for Risks due to Ablation

Thumar, et al.[8], offer the following guidelines regarding the potential risks of utilizing Ablation Therapy in reference to the location of the Tumor on the Kidney:
  • Ablation of Tumors in the Central Region may be associated with blood vessel stricture due to post-operative Hemorrhage; or Urinary Incontinence due to injury to the Urinary Collecting System
  • Ablation treatment of Tumors in the Lower-Pole may be associated with injuries to the Ureters
  • Ablation of Medial Tumors can be associated with Nerve injury if Psoas-Muscles are included in the area of Thermal Spread
  • Ablation treatment of Upper-Pole Tumors may be associated with Pleural Effusion of fluid in the Lungs or Pneumothorax collapse of the Lung
  • Ablation of Anterior Tumors can be associated with injury to Bowel or other Viscera