Urology Specialists of Sioux Falls Offers Cutting Edge Cryosurgery for Renal Cancer *Sponsored Feature*
Aug 21, 2015 03:32PM
By MED Magazine
By Alex Strauss
Anyone who has ever spent time outdoors in a Northern Plains winter likely understands the danger of frostbite. As the temperature drops, exposed tissue first becomes tingly, then painful, then numb. If not brought back into the safe temperature range, exposed fingers, toes or ears can sustain permanent damage within minutes.
Cryosurgery takes advantage of this same cellular sensitivity to freezing temperatures to target and destroy cancer cells. Board-certified urologist Matthew Witte, MD, of Urology Specialists in Sioux Falls says the technique has changed the way he and his colleagues approach renal carcinoma – particularly for patients who are not candidates for a more invasive surgical technique.
“This would typically be a patient with a solid renal mass that looks worrisome for cancer but who is elderly or has multiple comorbidities,” says Dr. Witte who performs the advanced technique along with his partner, board-certified urologist Michael Gillett, MD. “In the past, we would often have managed them with observation rather than trying to definitively treat the cancer. Now, we have another option.”
A Safer Alternative
Five years ago, Urology Specialists invested in the technology that allowed Drs. Witte and Gillett to begin offering fragile or elderly cancer patients and patients with compromised kidney function, a more promising treatment approach without the risks of open or laparoscopic surgery. In addition to being less traumatic for the body, cryosurgery carries the added benefit of destroying only the cancerous portion of the kidney while leaving the rest of the organ intact.
“Traditionally, patients who were candidates for surgery would have the whole kidney removed,” says Dr. Witte. “But there is more recent data that suggests that people tend to do better over time if you can preserve as much of the kidney as possible. This is the goal of a partial nephrectomy in people who are surgical candidates. Cryosurgery allows us to offer this same advantage to more people.”
Unlike open or laparoscopic procedures, both of which require general anesthesia and incisions and carry the usual surgical risks of infection, pain and bleeding, cryosurgery creates only a few tiny puncture wounds. In addition, patients who undergo cryosurgery (also called cryoablation) for their kidney cancer face a lower risk blood clots, heart attacks, stroke or death, with less pain and a faster recovery. Compared to other minimally invasive ablative techniques, such a radiofrequency ablation, cryoablation has less risks of damage to larger vessels, and less risk of developing a fistula.
The procedure is done under sedation using local anesthetic. Although patients could often go home the same day, Dr. Witte says most are kept in the hospital overnight for monitoring since many have multiple health problems.
Because the freezing temperatures used in cryosurgery (cancer cells die between minus 20 and minus 40 degrees Celsius) are so lethal to all body tissues, precision is critical. The procedure starts with a baseline CT scan of the kidney to locate the mass and to take a core tissue sample for the pathologist to review.
During the same session, lidocaine is injected and the patient is under mild sedation. Using CT guidance, a series of cryoprobes are inserted through the skin and into the tumor. The number of probes used depends on the size and shape of the tumor. Each probe can create a spherical ice ball that extends about a centimeter around its tip. For this reason, cryosurgery is usually reserved for masses smaller than about 4 centimeters.
When the probes are in place, Argon gas is circulated under pressure into a small chamber inside the tip of the needle where it expands and cools, reaching a temperature well below -100 Celsius. This produces an ice ball with a predictable size and shape. The freezing temperature is maintained for about ten minutes. Toward the end of that time, another CT scan is performed to gauge the treatment’s effect.
“Usually what you can see is that the mass itself turning very dark under CT imaging,” says Dr. Witte. “Depending on the treatment effect noted on imaging, you can determine whether you need to place additional cryoprobes.” Typically, two freeze/thaw cycles are used to ensure that the maximum number of cancer cells are destroyed. The most common complication is bleeding which occurs in 2 to 3 percent of cryosurgery patients.
At its outset, Dr. Witte says cryosurgery was “a new technique looking for an application.” Now, five years into their experience with the technique and with more than 130 cases under their belts, Drs. Witte and Gillett have some impressive outcome data to report.
“People have really done great with this,” says Dr. Witte. “Out of those 130 cases, only four have required retreatment. One person had progression of their disease. None of our other patients have died from their cancer.”
Urology Specialists now perform two to three cryosurgeries a month for kidney cancer and expect those numbers to continue to rise as the technique is refined and perfected. Although it is currently reserved primarily for poor surgical candidates, Dr. Witte says there are other advantages to cryosurgery that may make it a desirable option for more people in the future.
“For instance, people who have recurrent disease after partial nephrectomy. It is technically very difficult to re-operate on these people and many end up with the whole kidney removed, but conceivably you can treat them with cryosurgery and preserve the remaining normal kidney,” says Dr. Witte. “Now that we are starting to have more data on the efficacy, I expect that we are going to see more people using cryosurgery as a first line treatment, even in younger patients.”
Dr. Witte has one caveat for doctors of patients with suspected kidney cancer: Refer to a urologist first.
“If the patient has a biopsy first, it can create more problems than it solves, in that it might make it technically more difficult to do perform a partial nephrectomy later,” cautions Witte. “Because we understand the natural history of this disease and we know all the management options, we can help patients make the most informed decisions.”
Cryosurgery for Kidney Cancer
- Lower morbidity
- Fewer complications
- Overnight hospital stay
- Normal activity in three weeks
- Low pain (Usually Tylenol only)
- Little or no change in kidney function