Anthony Kodzo-Grey Venyo*
Abstract
Surgical excision, either by means of radical nephrectomy or by partial nephrectomy is the accepted gold-standard treatment of curative intent for localized carcinomas of the kidney (Stage T1 Renal carcinomas). Nevertheless, recent advances in medical technology has enabled the development of new minimally invasive treatment options for localized carcinomas of the kidney and one of these options is cryotherapy of localized renal carcinoma which have been used to treat these tumors in some specialized centres sporadically. Sporadic publications have illustrated that cryotherapy of small kidney tumors can be undertaken safely and with short hospital stay as well as near 100 percent destruction of tumour tissue. Cryotherapy of small renal tumors can be undertaken under radiological imaging control (contrast ultrasound scan, contrast CT scan, contrast MRI scan). Cryotherapy of small localized renal tumors can be undertaken by means of percutaneous cryotherapy of the kidney lesion, laparoscopic cryotherapy of the small renal lesion, or open surgical cryotherapy of the small renal lesion. Biopsies tend to be taken prior to the cryotherapy to confirm diagnosis of renal cell carcinoma or the cell type of tumour. Cryotherapy of small localized renal lesions can be undertaken in old patients and in patients with comorbidities without any significant complications. The short- and medium-term outcome, is similar to the gold standard laparoscopic/open partial nephrectomy, but the advantage of cryotherapy is that the procedure is less expensive and associated with short hospital stay and in the event of the occasional finding of residual disease this can be treated by further cryotherapy or surgical excision without jeopardizing the life of the patient. The renal function of patients who undergo cryotherapy of kidney tumors tends to be maintained in all cases. There is however, paucity of literature on cryotherapy of renal tumors with long follow-up. Summations related to cryotherapy of renal tumors would include the ensuing: Cryotherapy of small localized renal tumors tends to be associated with destruction of the renal tumors with hardly any residual disease and with similar short-term and medium-term oncologic and survival outcome as the gold standard surgical excisions and with short hospital stay and less cost. A multi-centre global trial of cryotherapy of small renal tumors with a long period of follow-up would be recommended to illustrate that cryotherapy of small renal tumors would be a strong competitive gold standard primary treatment option associated with minimal cost.