Kidney Cancer Ablation
Dr. David Breen
David Breen (university of Southampton Hospital) has the largest single operator published series of cases in the world. He is regarded as one of the pioneers of cryoablation, Europe's top operator for kidney cancer and regularly lectures and trains other professionals worldwide.
Benefits of cancer ablation
- Less invasive than "keyhole"
- Shorter hospital stay
- Return to work quicker
- Preserves normal tissue better than surgical techniques
- Incisionless and scarless
Kidney cancer is increasing worldwide. Overall 5 year survival figures are nearly 75%. With the increased use of CT and MRI imaging we are picking up these cancers earlier, often before symptoms have become apparent. Smaller cancers less than 3cm in diameter can be put under active surveillance (watching and waiting). Larger or growing tumours are often treated with surgery (nephrectomy or laparoscopic nephrectomy).
Kidney Cryoablation has evolved over the last 20 years and is now becoming the treatment of choice for smaller cancers less than 5cm across. It has several advantages over surgery that include being less invasive with shorter hospital stay. Cryoablation also preserves more normal kidney tissue than surgery making it ideal for patients with previous nephrectomy and patients who are likely to get a recurrence. It is superior to RFA.
As this procedure is less invasive than "keyhole surgery" many patients on surveillance are electing to choose biopsy with cryoablation as an alternative.
In 2010 kidney cancer cryotherapy was approved by NICE, the NHS body that assesses new drugs and procedures. To access that report click here
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Ablation or Surveillance?
Smaller kidney tumours used to be referred for surveillance. If they grow over time they are then treated. However tumour behaviour is not always predictable and we are finding more and more patients are choosing biopsy with ablation at the same time. As the tumour is small so are the risks of treatment and this is usually offered as a day case procedure.
How do I proceed?
The next step is to find out whether or not your tumour is amenable to ablation treatment. As a rule, small tumours, <5.5cm in diameter are most suitable. Larger tumours can only rarely be treated this way. Patients who need to preserve kidney tissue are particularly suited (VHL disease, previous surgery, patients with one kidney etc) Patients with spread of cancer to other organs cannot be treated as systemic therapy is the appropriate therapy.
The decision to ablate depends also on where your tumour is in relation to other major body structures and of course your overall health. Ablation is a hospital procedure that requires either general anaesthesia or deep sedation. Overall health is more important than age, indeed our oldest patient is aged 88.
CAUK have amongst the most extensive experience in Europe in Ablation Techniques. Cryoablation is particularly suited to kidney tumours. Under CT control, your radiologist can clearly visualise the ice that consumes and destroys the tumour. Most procedures are performed under general anaesthesia, not because the procedure is painful, but largely to aid with precision targeting of the tumour.
You will be called back for a CT or MR study a few weeks after the ablation to confirm that the whole tumour has been destroyed.