Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Ablative techniques for the management of kidney cancer

Nature Clinical Practice Urology volume 4, pages 261–269 (2007)Cite this article

Abstract

For lesions smaller than 4 cm, nephron-sparing surgery has been shown to be oncologically equivalent to radical nephrectomy, albeit with the advantage of preservation of overall renal function. As such, partial nephrectomy became the first-line treatment option for localized, small renal masses. Minimally invasive options associated with limited morbidity—such as probe-ablative procedures—are, however, being investigated in selected patients for whom invasive, nephron-sparing surgery (whether laparoscopic or open) is undesirable. The main probe-ablative techniques being investigated as alternatives to partial nephrectomy are cryoablation, radiofrequency ablation, and high-intensity focused ultrasound. Advances in imaging, ablative system technologies, and early evidence that in situ tumor ablation can yield comparable results to those achieved with tumor resection in selected cases, have sparked significant interest in these minimally invasive techniques.

Key Points

  • Although partial nephrectomy is the first-line treatment option for lesions smaller than 4 cm, this approach is not suitable for all patients, especially those at raised risk of surgical complications

  • Initial clinical reports with intermediate follow-up indicate that laparoscopic renal cryotherapy is technically feasible, safe, and associated with good oncological outcomes, but use of this technique should be limited to small, solid renal tumors in older patients at high surgical risk until long-term data become available

  • Percutaneous cryotherapy with either CT or MRI guidance is an attractive method of treatment, but its oncological efficacy needs to be validated in long-term studies

  • The initial experiences with radiofrequency ablation in small studies with limited follow-up have highlighted some technical challenges associated with this technology that must be resolved before this technique can be adopted for widespread clinical use

  • Renal high-intensity focused ultrasound is still experimental and has limited success; further refinements are clearly necessary before this technique can be clinically used to treat renal lesions

Access through your institution
Buy or subscribe

This is a preview of subscription content, access via your institution

Access options

Access through your institution

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1: Intraoperative images obtained during laparoscopic cryoablation of a renal mass
Figure 2: CT scan during percutaneous cryoablation of a renal mass
Figure 3: CT scan during percutaneous radiofrequency ablation of a renal mass, using a probe with multiple tines

Similar content being viewed by others

References

  1. Chow WH et al. (1999) Rising incidence of renal cell cancer in the United States. JAMA 281: 1628–1631

    Article  CAS  Google Scholar 

  2. Bretheau D et al. (1995) Prognostic significance of incidental renal cell carcinoma. Eur Urol 27: 319–323

    Article  CAS  Google Scholar 

  3. Jayson M and Sanders H (1998) Increased incidence of serendipitously discovered renal cell carcinoma. Urology 51: 203–205

    Article  CAS  Google Scholar 

  4. Homma Y et al. (1995) Increased incidental detection and reduced mortality in renal cancer—recent retrospective analysis at eight institutions. Int J Urol 2: 77–80

    Article  CAS  Google Scholar 

  5. Fergany AF et al. (2000) Long-term results of nephron sparing surgery for localized renal cell carcinoma: 10-year followup. J Urol 163: 442–445

    Article  CAS  Google Scholar 

  6. Lee CT et al. (2000) Surgical management of renal tumors 4 cm or less in a contemporary cohort. J Urol 163: 730–736

    Article  CAS  Google Scholar 

  7. Lutzeyer W (1972) Advancements in operative therapy (urology). Langenbecks Arch Chir 332: 137–145

    Article  CAS  Google Scholar 

  8. Lutzeyer W et al. (1968) Experimental cryosurgery of the kidney. Langenbecks Arch Chir 322: 843–847

    Article  CAS  Google Scholar 

  9. Uchida M et al. (1995) Percutaneous cryosurgery for renal tumours. Br J Urol 75: 132–136

    Article  CAS  Google Scholar 

  10. Delworth MG et al. (1996) Cryotherapy for renal cell carcinoma and angiomyolipoma. J Urol 155: 252–255

    Article  CAS  Google Scholar 

  11. Gill IS et al. (1998) Laparoscopic renal cryoablation: initial clinical series. Urology 52: 543–551

    Article  CAS  Google Scholar 

  12. Davol PE et al. (2006) Long-term results of cryoablation for renal cancer and complex renal masses. Urology 68 (Suppl): 2–6

    Article  Google Scholar 

  13. Gill IS et al. (2005) Renal cryoablation: outcome at 3 years. J Urol 173: 1903–1907

    Article  Google Scholar 

  14. Kaouk JH et al. (2006) Cryotherapy: clinical end points and their experimental foundations. Urology 68: 38–44

    Article  Google Scholar 

  15. Hoffmann NE and Bischof JC (2002) The cryobiology of cryosurgical injury. Urology 60 (Suppl 1): 40–49

    Article  Google Scholar 

  16. Chosy SG et al. (1998) Monitoring renal cryosurgery: predictors of tissue necrosis in swine. J Urol 159: 1370–1374

    Article  CAS  Google Scholar 

  17. Campbell SC et al. (1998) Renal cryosurgery: experimental evaluation of treatment parameters. Urology 52: 29–34

    Article  CAS  Google Scholar 

  18. Woolley ML et al. (2002) Effect of freezing parameters (freeze cycle and thaw process) on tissue destruction following renal cryoablation. J Endourol 16: 519–522

    Article  Google Scholar 

  19. Permpongkosol S et al. (2006) Percutaneous renal cryoablation. Urology 68 (Suppl): 19–25

    Article  Google Scholar 

  20. Gupta A et al. (2006) Computerized tomography guided percutaneous renal cryoablation with the patient under conscious sedation: initial clinical experience. J Urol 175: 447–453

    Article  Google Scholar 

  21. Shingleton WB and Sewell PE Jr (2001) Percutaneous renal tumor cryoablation with magnetic resonance imaging guidance. J Urol 165: 773–776

    Article  CAS  Google Scholar 

  22. Sewell P and Shingleton WB (2004) Five-year treatment success and survival of patients treated with percutaneous IMRI guided and monitored renal cell carcinoma cryoablation. BJU Int 94 (Suppl 2): S106

    Google Scholar 

  23. Shingleton WB and Sewell PE Jr (2002) Percutaneous renal cryoablation of renal tumors in patients with von Hippel–Lindau disease. J Urol 167: 1268–1270

    Article  Google Scholar 

  24. Zlotta AR et al. (1997) Radiofrequency interstitial tumor ablation (RITA) is a possible new modality for treatment of renal cancer: ex vivo and in vivo experience. J Endourol 11: 251–258

    Article  CAS  Google Scholar 

  25. McGovern FJ et al. (1999) Radio frequency ablation of renal cell carcinoma via image guided needle electrodes. J Urol 161: 599–600

    Article  CAS  Google Scholar 

  26. Farrell MA et al. (2003) Imaging-guided radiofrequency ablation of solid renal tumors. AJR Am J Roentgenol 180: 1509–1513

    Article  CAS  Google Scholar 

  27. Roy-Choudhury SH et al. (2003) Early experience with percutaneous radiofrequency ablation of small solid renal masses. AJR Am J Roentgenol 180: 1055–1061

    Article  Google Scholar 

  28. Hwang JJ et al. (2004) Radio frequency ablation of small renal tumors: intermediate results. J Urol 171: 1814–1818

    Article  CAS  Google Scholar 

  29. Pavlovich CP et al. (2002) Percutaneous radio frequency ablation of small renal tumors: initial results. J Urol 167: 10–15

    Article  Google Scholar 

  30. Varkarakis IM et al. (2005) Percutaneous radio frequency ablation of renal masses: results at a 2-year mean followup. J Urol 174: 456–460

    Article  Google Scholar 

  31. Zagoria RJ et al. (2004) Percutaneous CT-guided radiofrequency ablation of renal neoplasms: factors influencing success. AJR Am J Roentgenol 183: 201–207

    Article  Google Scholar 

  32. Gervais DA et al. (2005) Radiofrequency ablation of renal cell carcinoma: part 1, indications, results, and role in patient management over a 6-year period and ablation of 100 tumors. AJR Am J Roentgenol 185: 64–71

    Article  Google Scholar 

  33. Lewin JS et al. (2004) Phase II clinical trial of interactive MR imaging-guided interstitial radiofrequency thermal ablation of primary kidney tumors: initial experience. Radiology 232: 835–845

    Article  Google Scholar 

  34. Jacomides L et al. (2003) Laparoscopic application of radio frequency energy enables in situ renal tumor ablation and partial nephrectomy. J Urol 169: 49–53

    Article  Google Scholar 

  35. Lui KW et al. (2003) Radiofrequency ablation of renal cell carcinoma. Clin Radiol 58: 905–913

    Article  Google Scholar 

  36. Goldberg SN et al. (1996) Radio-frequency tissue ablation of VX2 tumor nodules in the rabbit lung. Acad Radiol 3: 929–935

    Article  CAS  Google Scholar 

  37. Chong WK (2001) Radiofrequency ablation of liver tumors. J Clin Gastroenterol 32: 372–374

    Article  CAS  Google Scholar 

  38. Goldberg SN et al. (2000) Thermal ablation therapy for focal malignancy: a unified approach to underlying principles, techniques, and diagnostic imaging guidance. AJR Am J Roentgenol 174: 323–331

    Article  CAS  Google Scholar 

  39. Goldberg SN et al. (1996) Radiofrequency tissue ablation: importance of local temperature along the electrode tip exposure in determining lesion shape and size. Acad Radiol 3: 212–218

    Article  CAS  Google Scholar 

  40. Hegarty NJ et al. (2006) Probe-ablative nephron-sparing surgery: cryoablation versus radiofrequency ablation. Urology 68 (Suppl): 7–13

    Article  Google Scholar 

  41. Sung GT et al. (2003) Effect of intentional cryo-injury to the renal collecting system. J Urol 170: 619–622

    Article  Google Scholar 

  42. Janzen NK et al. (2005) The effects of intentional cryoablation and radio frequency ablation of renal tissue involving the collecting system in a porcine model. J Urol 173: 1368–1374

    Article  Google Scholar 

  43. Michaels MJ et al. (2002) Incomplete renal tumor destruction using radio frequency interstitial ablation. J Urol 168: 2406–2410

    Article  Google Scholar 

  44. Hegarty NJ et al. (2006) Lack of enhancement on 6-month MRI does not guarantee complete cancer cell kill following radiofrequency ablation of small renal tumors [abstract]. J Urol 175 (Suppl): 552

    Article  Google Scholar 

  45. Johnson DB et al. (2004) Defining the complications of cryoablation and radio frequency ablation of small renal tumors: a multi-institutional review. J Urol 172: 874–877

    Article  Google Scholar 

  46. Kohrmann KU et al. (2002) Technical characterization of an ultrasound source for noninvasive thermoablation by high-intensity focused ultrasound. BJU Int 90: 248–252

    Article  CAS  Google Scholar 

  47. Hacker A et al. (2006) Extracorporeally induced ablation of renal tissue by high-intensity focused ultrasound. BJU Int 97: 779–785

    Article  Google Scholar 

  48. Kohrmann KU et al. (2002) High intensity focused ultrasound as noninvasive therapy for multilocal renal cell carcinoma: case study and review of the literature. J Urol 167: 2397–2403

    Article  Google Scholar 

  49. Marberger M et al. (2005) Extracorporeal ablation of renal tumours with high-intensity focused ultrasound. BJU Int 95 (Suppl 2): 52–55

    Article  Google Scholar 

  50. Wu F et al. (2003) Preliminary experience using high intensity focused ultrasound for the treatment of patients with advanced stage renal malignancy. J Urol 170: 2237–2240

    Article  Google Scholar 

  51. Remer EM et al. (2000) MR imaging of the kidneys after laparoscopic cryoablation. AJR Am J Roentgenol 174: 635–640

    Article  CAS  Google Scholar 

  52. Anderson JK et al. (2006) Imaging associated with percutaneous and intraoperative management of renal tumors. Urol Clin North Am 33: 339–352

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. J Hafron is a Clinical Fellow in Advanced Laparoscopy and Robotics and JH Kaouk is the Director of Robotic Urologic Surgery in the Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, Cleveland Clinic, Cleveland, OH, USA.,

    Jason Hafron & Jihad H Kaouk

Authors
  1. Jason Hafron
    View author publications

    Search author on:PubMed Google Scholar

  2. Jihad H Kaouk
    View author publications

    Search author on:PubMed Google Scholar

Corresponding author

Correspondence to Jihad H Kaouk.

Ethics declarations

Competing interests

Jason Hafron declared he has no competing interests. Jihad H Kaouk lectures for and has received sponsorship for research from Endocare Inc, Irvine, CA, USA.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hafron, J., Kaouk, J. Ablative techniques for the management of kidney cancer. Nat Rev Urol 4, 261–269 (2007). https://doi.org/10.1038/ncpuro0802

Download citation

  • Received:

  • Accepted:

  • Issue date:

  • DOI: https://doi.org/10.1038/ncpuro0802

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing