A19 Session 5: General Urology : The role of cryoablation in the contemporary management of the small renal cortical neoplasm: Thoughtful marriage of biology and technology

Abstract

The past several decades have been tumultuous with regards to the diagnosis and management of the small renal cortical neoplasm. This significance of this challenge has been exacerbated by the explosive increase in the use of axial imaging technologies, commensurate robust increase in the number of renal tumors which are discovered annually, and increasing pressures to limit healthcare expenditures. All the while, these changes are occurring in light of increased patient expectations for truly “minimally invasive” management options. Remarkable recent changes in our understanding of the epidemiology and biology of the small renal cortical neoplasm have been paralleled by the rapid introduction of biotechnologies and techniques. Active surveillance data has clearly demonstrated the indolent nature of the majority of incidentally discovered small renal lesions. Simultaneously, the critical importance of proper small renal cortical neoplasm diagnosis, including the once taboo concept of renal mass biopsy, is being reconsidered globally. Finally, the Urologic community is now understanding of the major impact of renal function on cardiovascular health and long-term patient survival. From a technological perspective, laparoscopy, robotics and LESS surgery have engendered much interest in the Urologic community. Over time, these technologies have been readily accepted. However, while incremental improvements, laparoscopy, robotics and LESS represent modified access mechanisms, and therefore are maintenance of the existing extirpative gold standard. Remarkably, the concept of ablation has gained limited traction in the Urologic community. Ablation technologies such as cryoablation can be deployed percutaneously under CT or MRI guidance offering the least invasive option for active management. Similarly, longer-term results have demonstrated both excellent oncologic control, safety, and the ability to optimally preserve renal function. The current lecture will review the salient epidemiologic and biologic features of the small renal cortical neoplasm, the importance of pre-treatment biopsy, and the advantages and limitations of contemporary cryoablation.