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