Endophytic Lesions: A Predictor Of Failure In Laparoscopic Renal Cryoablation

The tissue ablative techniques for renal tumor management continue to be in their investigational phase. This group highlights the technical limitations associated with cryotherapy of anteriorly located, endophytic tumors. These tumors are often not amenable to percutaneous CT guided cryotherapy and therefore are approached laparoscopically. If endophytic, as opposed to exophytic, these tumors can be very difficult to accurately locate visually even with intra-operative, laparoscopic ultrasound imaging. In this study of laparoscopic cryotherapy for 35 renal tumors, multivariate analysis showed that only the endophytic nature of the tumor was a clear predictor of failure of the treatment, because these treatments are heavily reliant on intra-operative ultrasound targeting. Until intra-operative laparoscopic imaging can be significantly improved these cryotherapy failures will continue to occur due to technical error. These patients must be closely surveilled to identify any treatment failure and retreated expeditiously.