1. Renal Cryoablation

2. 1. Morbidity 2. Efficacy Cancer Free Survival (NED) Cancer Free Survival (NED) Cancer Specific Survival Cancer Specific Survival Post renal cryoablation metastases Post renal cryoablation metastases

3. Morbidity Deane and Clayman review (2006): n= 320, Major complications: < 1% Johnson et al (2004): multicenter of 139 patients: Major: n = 2 (1 %) Significant hemorrhage : n=1 Conversion from laparoscopic to open: n=1 Minor: n = 17 (12 %) Transient probe site pain: n=10 Post-op UTI: n=2 Post-op pneumonia infection: n=2 Minor hemorrhage: n=1 Wound infection: n=1 Respiratory difficulty: n=1 Deane LA & Clayman RC, Urology 2006 68 (Suppl 1A): 26-37 Johnson et al J Urology 2004; 172 pp 874-877

4. Efficacy 1. Cancer free survival (no pathologic evidence of disease) 2. Cancer specific survival (RCC specific) 3. Post cryoablation metastases

5. 0 20 40 60 80 100 3-years 4-years5-years 95% 2 96.4% 1 96.6% 3 97.5% 5* 93.3% 6 Percent 1. Gill et al, J Urol. 2005 Jun;173(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 Cancer Free Survival Following Renal Cryoablation 95% 4

6. 0 20 40 60 80 100 3-years 4-years5-years 100% 2 98% 1 100% 3 100% 5 100% 6 Percent Cancer Specific Survival Following Renal Cryoablation 100% 4 1. Gill et al, J Urol. 2005 Jun;173(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 Campbell’s 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: SeriesReference No. Pts. Mean F/u (mo) Hegarty Urology 2006 16136 Davol 7264 Lawatsch Journal of Urology 2006 5924.5 Hegarty 2006 AUA 6072 Gill Journal of Urology 2005 5643

8. 0 20 40 60 80 100 Partial Nephrectomy Cryoablation Percent Cryo vs. Partial Nephrectomy: Cancer Specific Survival 1. Andrew C. Novick and Steven C. Campbell. Renal Tumors. In: Campbell’s Urology 8th Edition 2. Nicholas J. Hegarty, et al. 2006 Jul;68(1 Suppl):7-13. 3. Patrick E. Davol, et al. Urology. 2006 Jul;68(1 Suppl):2-6. 4. Lawatsch EJ, et al. J Urol. 2006 Apr;175(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 Jun;173(6):1903-7.

9. 0 2 4 6 8 10 Partial Nephrectomy Cryoablation Percent Cryo vs. Partial Nephrectomy:Recurrence Rate Cryo vs. Partial Nephrectomy: Local Recurrence Rate 1. Andrew C. Novick and Steven C. Campbell. Renal Tumors. In: Campbell’s Urology 8th Edition 2. Nicholas J. Hegarty, et al. 2006 Jul;68(1 Suppl):7-13. 3. Patrick E. Davol, et al. Urology. 2006 Jul;68(1 Suppl):2-6. 4. Lawatsch EJ, et al. J Urol. 2006 Apr;175(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 Jun;173(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 Jun;173(6):1903-7