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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 7 of 11

Table 2. Contemporary comparative series comparing cryoablation with different nephron sparing treatment options with
oncological outcomes
Number of Follow up
Author Year End point Therapy Study design Outcomes
patients (months)
Kim et al. [58] 2014 Survival, recurrence, PCA 118 Prospective 38 17%, 86.3%, 86.3%
complications, renal LCA 145 evaluation 71.4 (RR, OS, RFS)
function 23%, 79.3%, 85.5%
(RR, OS, RFS)
El Dib et al. [59] 2012 Survival, recurrence, CA 457 Retrospective 17.9 89% CE
complications RFA 426 18.1 90% CE
Atwell et al. [60] 2013 Survival, recurrence, PCA 163 Retrospective 1.8 2.8%, 95.6% (RR, RFS)
complications, RFA 222 36 (mean) 3.2%, 97-2% (RR, RFS)
Tanagho et al. [61] 2013 Survival, recurrence, LCA/PCA 267 Retrospective 39.8 12.7%, 83.1%, 96.4%,
complications, renal RPN 233 21.9 77.1% (RR, DFS, CSS, OS)
function 0%, 100%, 100%, 91.7%
(RR, DFS, CSS, OS)
Guillotreau et al. [62] 2012 Survival, recurrence, RPN 210 Retrospective 4.8 0% (RR)
complications, renal LCA 226 44.5 (mean) 11% (RR)
function
Klatte et al. [63] 2014 Recurrence, LCA - Retrospective - 9.4% vs. 0.4%
(meta-analysis) complications LPN/RPN
Metastasis
4.4% vs. 0.4%
Thompson et al. [64] 2015 Survival, recurrence, CA 187 Retrospective 1.9 3%, 98%, 100%, 88%
complications, RFA 180 3.6 (RR, RFS, MSF, OS)
renal function PN 1,057 60 5%, 98%, 93%, 82%
(RR, RFS, MSF, OS)
36%, 98%, 99%, 95%
(RR, RFS, MSF, OS)
RFA: radiofrequency; PN: partial nephrectomy; RN: radical nephrectomy; LCA: laparoscopic cryoablation; PCA: percutaneous cryoablation;
RPN: robotic partial nephrectomy; LPN: laparoscopic partial nephrectomy; CE: cancer extirpation rate; RR: recurrence rate; OS: overall
survival; CSS: cancer-specific survival; DFS: disease-free survival; MSF: metastasis-free survival; RFS: recurrence-free survival

[33]
RFA seems to be no different in Clavien complication rate in comparison to CA, however, Goel et al.
founded a lower rate of complication for CA compared with RFA, probably because the freezing-induced
injury is less destructive than heat-induced one [33,34] . Generally, the most common complications during the
procedure or post-operative are bleeding and rupture of the iceball.

There is no consensus on the definition of recurrence after treatments for SRM and particularly after AT.
Local recurrences mostly occur at the site of the primary treatment within the kidney. Conversely, extra-
renal local recurrences are rare [35,36] . Today, most analyses have shown lower specific cancer mortality for
PN compared to non-surgical treatments. In general, local recurrence rates after CA are higher than after
surgery (2%-11% vs. 1%-2%) [37,38] .

Ideally, histopathological confirmation and re-biopsy of previously treated lesions would improve data of
recurrent or residual disease. Conversely, in the literature, the majority of reports relied on radiographic
evidence of enhancement to define both residual and recurrent disease. PCA had a higher rate of residual
disease/primary treatment failure in comparison to LCA: PCA residual disease seems to be more frequent
and to occur earlier than LCA, even if the length of follow-up between groups is difference (approximately
[29]
14 months longer for LCA) .
Zargar et al. found no significant difference in OS or RFS at 5 years between PCA and LCA. Conversely,
[30]
in other studies seems that a lower rate of patients in the LCA group experienced a local recurrence as
compared with the rate of PCA group .
[30]

Factors that might have contributed to the differences in residual and recurrent disease between PCA and
LCA are the size of the lesion, the anatomical location, and the probe size and number (in LCA tendency to
use wider probes).