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Silvestri et al. Mini-invasive Surg 2019;3:5 I http://dx.doi.org/10.20517/2574-1225.2018.67 Page 5 of 11

Figure 3. First freezing cycle

Figure 4. Under ultrasound evaluation the needle is carefully removed

outcomes of CA and RFA. Generally, low-quality studies suggest a higher local recurrence rate for thermal
ablation therapies compared to PN. Nevertheless, in currently comparative series no significant differences
were reported for OS, CSS, or RFS between RFA and CA . Considering PN as a comparator, recently a
[1]
meta-analysis reported similar complication rates and postoperative functional outcomes between RFA and
[26]
PN . The local tumor recurrence rate was higher in the RFA group than in the PN group but there was no
difference regarding the occurrence of distant metastasis. Although the majority of series are retrospective
and with different follow-ups, recent studies with a long-term follow-up showed that no statistical difference
was found in the 5-year OS, CCS, DFS, and local RFS of RCC patients between RFA treatment and PN
[27]
[28]
treatment [Table 1] . Johnson et al. presented data of SRMs with a diameter less than 3 cm with a
median follow up of more than 6 years and a subgroup of patients with a minimum 10-year follow up with
imaging. The 6-year disease-free recurrence rate of 89% is consistent with the prior published data. This
data could suggest that for lesions less than 3 cm RFA oncologic outcomes were similar to efficacy rates of
[28]
extirpative surgery . Regarding CA different studies compared open, laparoscopic or robotic PN with PCA
or LCA [Table 2]. Oncological outcomes were mixed, not all studies reported all outcomes listed, and some
were small and included benign tumors. Globally no study showed an oncological benefit for cryoablation
over PN.

Overall, studies comparing renal function before and after CA and PN suggest a degree of functional decline
following CA similar to PN. However, in most cases, this is not clinically significant because baseline
characteristics of lesions, function and the patient’s comorbidities were different. No significant difference