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UroToday.com - In situ thermal destruction of renal masses through the creation of lethal cold temperatures has become an acceptable treatment option for patients with incidentally discovered small renal lesions. Few long-term studies have been published to examine the efficacy and safety of the procedure. In a recent review, P. E. Davol, D. Rukstalis and colleagues from Geisinger Health System in Danville, Pennsylvania, the long-term results of cryosurgical ablation of renal neoplasms is reported. The report is published in the July 2006 issue of Urology. A retrospective review of a cohort of 48 patients treated with either open (n = 24) or laparoscopic (n = 24) cryoablation of worrisome renal masses who had at least 36 months of follow-up (median 64 months) was completed. Patient demographics, tumor characteristics, radiologic follow-up and disease-free and overall survival data were evaluated. Follow-up imaging was by MRI very frequently initially but has evolved to one post-op MRI at 3-months post-op and then every 6 months thereafter. Radiographic success was defined as an involuted scar or fibrosis without evidence of growth or enhancement on the most recently available imaging study. Analysis of the results showed a mean age of the cohort to be 62 years. The mean size of the renal mass was 2.6 cm. Forty-four lesions were exophytic, 4 were central, 38 masses were solid, and 11 were cystic but suspicious. A total of 12.5% of patients were diagnosed with persistent disease during the follow-up period. The failures were treated with either laparoscopic nephrectomy (n = 2), laparoscopic partial nephrectomy (n = 1), repeat cryoablation (n = 1) and one elected observation. This patient experienced distant lung metastasis after 60 months of follow-up. Overall cancer specific survival was 100% and the cancer-free survival rate after a single cryoablation procedure was 87.5%. This improved to 97.5% after a repeat procedure. No major complications were observed. This data suggests that cryosurgical ablation of renal neoplasms can lead to acceptable long-term disease free survival. Careful radiologic follow-up strategies are crucial in monitoring treatment success and identifying those who may require a secondary salvage procedure. Davol PE, Fulmer BR, Rukstalis DB Urology. 2006 Jul; 68(supp 1A):2-6 Reviewed By UroToday.com Contributing Editor Michael J. Metro, M.D. UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice. To access the latest urology news releases from UroToday,
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