Kidney cryoablation

Each year, more than 11,000 new kidney cancers are diagnosed. Kidney cancer may be discovered fortuitously from an imaging test or suspected due to symptoms (such as pain or hematuria). Generally, the diagnosis is confirmed by a biopsy or a simple analysis of the imaging data. The case is then discussed at a multidisciplinary team meeting to determine the best possible treatment and care for the patient.

Kidney cryoablation is an alternative to surgery for the treatment of kidney tumors measuring up to six centimeters (stages T1a and T1b), although the best results are obtained with tumors measuring under three centimeters. This minimally invasive procedure is percutaneous, meaning it is performed using needles inserted through the patient's skin with imaging guidance. Because it requires no surgical incision, this technique facilitates post-operative care, causes no blood loss and enables early rehabilitation. Cryotherapy is now recommended as first-line therapy by the North American Cancer Society for small kidney tumors.

The interventional radiology team at the American Hospital of Paris led the way in developing kidney cryoablation in France, since our physicians have over 10 years of experience with cryotherapy and were among the first in France to use it. Our interventional radiologists specializing in oncology have significantly contributed to the growth of this technique, for example, at cancer research centers Institut Curie and Institut Gustave Roussy. Each year they perform a large number of cryotherapy procedures involving the lung, the liver, the breast and soft tissue, in addition to the kidney.

The American Hospital of Paris provides the full array of diagnostic and testing services and specialists (medical imaging, oncology and surgery) enabling a complete assessment of kidney cancer as well as any associated conditions.

In addition, the American Hospital of Paris has an interventional radiologist on call 24/7 in the event of a problem or a question following the procedure.

• Using modern image-guided techniques and latest-generation radiology equipment, an interventional radiologist inserts one or several needles into the tumor.
   
• The tips of these needles are then brought to an extremely cold temperature, creating an ice ball that surrounds and destroys the tumor.
   
• CT-scan guidance makes it possible to see the exact position and size of the ice ball and ensure that it completely encompasses the tumor along with a necessary safety margin of tissue.
   
• After the procedure, the radiologist withdraws the needles and applies a bandage over the puncture sites.

1. The kidney is accessed using needles. No surgical incision is required.
    
2. The needles, inserted into the patient’s tumor, become cold when a gas is circulated inside them. The gas may be liquid nitrogen or argon, depending on the system used.
    
3. An ice ball forms around the needles, engulfing the entire tumor.
    
4. The temperature of the ice ball reaches a low of -180°, which destroys the tumor cells.
    
5. After a sufficient duration of cold treatment, the needles are reheated and withdrawn.

The main benefit of this technique is that it is minimally invasive, since it is performed through needles, enabling speedy, largely painless recovery.

Prior to the procedure, you will meet with an interventional radiologist and an anesthesiologist for a consultation.

On the day of the procedure, after arriving at the Hospital, you will be accompanied to the interventional radiology room, where the radiologist will meet you. The anesthesiologist and their team will prepare you for the procedure, for example by inserting an IV. The procedure lasts between 30 minutes and an hour.

Kidney cryoablation can be performed under conscious sedation or general anesthesia.

Once the procedure is over, you will be monitored for an hour in the post-anesthesia care unit, and then for a few more hours in ambulatory care. Typically, you will be able to return home four hours after the procedure. In some cases (for fragile patients or patients on anticoagulants), monitoring may continue overnight.

Rehabilitation after the procedure is rapid. Patients are able to walk and return to normal activity that same day. No wound care is required.

During your consultation with the interventional radiologist, you will learn about the procedure and the steps involved. This is a very important part of your medical care. It is an opportunity for you to ask any questions you have.

Our radiologists work with other American Hospital of Paris specialists, facilitating a multidisciplinary assessment of your case before treatment. If there is any uncertainty about the diagnosis or appropriate course of action, additional laboratory or imaging tests may be prescribed.

The expected rate of complete tumor destruction is over 90%.

No large incision is made, only a needle puncture a few millimeters long. Consequently, no post-operative wound care is needed. There is no blood loss during the procedure.

The procedure can be performed in ambulatory care, requiring only a half-day of hospitalization.

If there is a recurrence, all treatment options remain open, including a second cryotherapy session.

Cryotherapy is now recommended as first-line therapy by the North American Cancer Society for small kidney tumors.

To date, there has been no prospective randomized trial comparing cryotherapy to surgery for small kidney tumors. To date, the retrospective study covering the longest period and the largest number of patients was carried out at the Mayo Clinic in the United States. It showed no difference in 5-year cancer recurrence between patients who underwent surgery or cryoablation: https://www.europeanurology.com/article/S0302-2838(19)30340-9/fulltext

• The rate of major complications is less than 3%.
• The main risks are post-operative hematoma or infection.
• There are a few minor complications, such as post-ablation syndrome involving a low fever and some signs of local irritation. The syndrome disappears spontaneously within a few days.