A biographical report of my Kidney Cancer Cryosurgical treatment. By K Henley. Revised 10 February 2006

Cryosurgery for kidney cancer was first introduced in 1999. It involves freezing tissue to extremely cool temperatures   (-190 Celsius) in order to kill the cells. The mechanism of this includes destruction of the cell wall, orgenelles within the cell and prohibiting blood from circulating. With the advent of newer delivery systems and ultrasound guidance one can destroy a focal area of tissue/cancer with accuracy up to 2.5mm.

Dermatologists have the most experience with cryosurgery for treating cancers of the skin. Within the last decade urologists have chosen to use this technology for the treatment of prostate cancer. Most recently other applications have been explored including the use of treating liver cancer, bone and kidney cancer.

At New York Presbyterian Hospital they are most interested in utilizing cryosurgery for the treatment and cure of small kidney cancers. About half of all patients with kidney cancer are diagnosed "incidentally". That is a test such as an ultrasound or CT scan was ordered for another issue and "incidentally" a kidney tumour was discovered.

Small isolated tumours treatments options consist of removing part if not all the kidney. Another treatment option being investigated is cryosurgery of the kidney tumour. For patients with only one kidney or decreased renal function, where removal of a portion of the entire kidney would mean dialysis for life, cryosurgery holds great promise.

Cryosurgery of the kidney is performed laparoscopically. Three ports are placed to allow access to the kidney and site of tumour. Using ultrasound guidance the cryoprobe is placed in the centre of the lesion. The probe then is cooled to minus Ç190 Celsius creating an ice ball. Using ultrasound and specially designed temperature probes, the tumour and tissue surrounding it for 1cm. is cooled to minus Ç40 Celsius.

The advantage includes minimally invasive (no blood loss, no surgical incision, outpatient surgery) and short recuperation period. The procedure can be repeated if the first cryosurgery has failed, radical surgery is still an option if the first cryosurgery fails.

Several investigators have performed and followed patients undergoing cryosurgery of kidney cancer. Operative time is under 2 hours - hospital stay is 3 days or less, estimated blood loss is negligible and complications are extremely rare.

Results in terms of cancer control are promising. Patients on follow-up CT scan have has no evidence of recurrence with follow-up out to 5 years. In patients who underwent biopsy of the cryosurgically-treated cancer no evidence of tumour was identified. This technique has great promise in the arsenal against kidney cancer. Unfortunately this treatment is not widely available due to the slow training of the specialists and the availability of the unique equipment used in the surgery. At this time, only a few hospitals in Europe are able to use this procedure, it is not available in the United Kingdom on the NHS yet.

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