BlueCross BlueShield of Tennessee Medical Policy Manual

Cryosurgical Ablation for Treatment of Renal Tumors

DESCRIPTION

Cryosurgical ablation (cryoablation or cryosurgery) involves exposing tissues to extreme cold in order to produce well-demarcated areas of cell injury and destruction. The tissue is cooled below -20 degrees C. The cold is usually produced by use of a probe containing liquid nitrogen. Cryosurgical ablation may be performed as an open surgical technique, percutaneously, or laparoscopically with ultrasound, magnetic resonance imaging (MRI), or computed tomography (CT) guidance.

POLICY

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MEDICAL APPROPRIATENESS

IMPORTANT REMINDERS

SOURCES

American Urological Association. (2013). Follow-up for clinically localized renal neoplasms: AUA guideline. Retrieved November 30, 2015 from: http://www.guideline.gov. (NGC#009917)

Bhindi, B., Thompson, R., Mason, R., Haddad, M., Geske, J., Kurup, A., (2017, June) Comprehensive assessment of renal tumour complexity in a large percutaneous cryoablation cohort. BJU International, 119 (6), 905-912. Abstract retrieved September 26, 2017 from PubMed database.

BlueCross BlueShield Association. Medical Policy Reference Manual. (8:2016). Cryosurgical ablation of miscellaneous solid tumors other than liver, prostate, or dermatologic tumors (7.01.92). Retrieved September 26, 2017 from BlueWeb. (49 articles and/or guidelines reviewed)

Chen, J. X., Guzzo, T. J., Malkowicz, S. B., Soulen, M. C., Wein, A. J., Clark, T. W., et al. (2016). Complication and readmission rates following same-day discharge after percutaneous renal tumor ablation. Journal of Vascular Interventional Radiology, 27 (1), 80-86. Abstract retrieved November 9, 2016 from PubMed database.

Kim, D., Wood, C., & Karam, J. (2014). Treating the two extremes in renal cell carcinoma: management of small renal masses and cytoreductive nephrectomy in metastatic disease. Retrieved November 30, 2015 from www.asco.org/edbook. 

Martin, J., & Athreya, S. (2013). Meta-analysis of cryoablation versus microwave ablation for small renal masses: is there a difference in outcome? Diagnostic Interventional Radiology, 19, 501-501. (Level 4 evidence - Independent)

Moynagh, M. R., Schmit, G. D., Thompson, R. H., Boorjian, S. A., Woodrum, D. A., Curry, T. B., et al. (2015). Percutaneous cryoablation of clinical T2 (> 7 cm) renal masses: technical considerations, complications, and short-term outcomes. Journal of Vascular Interventional Radiology, 26 (6), 800-806. Abstract retrieved November 9, 2016 from PubMed database.

National Comprehensive Cancer Network. (2017, September). NCCN clinical practice guidelines in oncology (NCCN Guidelines®) Kidney cancer. (V.1.2018). Retrieved September 26, 2017 from the National Comprehensive Cancer Network.

Rodriguez, F. O., Akdogan, B., Marszalek, M., Langenhuijsen, J. F., Brookman-May, S. Stewart, G. D. (2016). Current status of focal cryoablation for small renal masses. Urology, 90, 9-15. Abstract retrieved November 9, 2016 from PubMed database.

U. S. Food and Drug Administration. (2003, August). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K032333 (Cryocare™). Retrieved November 30, 2015 from: http://www.accessdata.fda.gov.

U. S. Food and Drug Administration. (2003, May). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K031117 (SeedNet™). Retrieved November 30, 2015 from http://www.accessdata.fda.gov.   

Winifred S. Hayes, Inc. Medical Technology Directory. (2014, June; last update search May 2017) Percutaneous cryoablation for the treatment of renal masses. Retrieved November 9, 2016 from www.Hayesinc.com/subscribers.  (58 articles and/or guidelines reviewed)

Yan, X., Zhang, M., Chen, X., Wei, W., Yang, R., Yang, Y., et al. (2015). Image-guided percutaneous renal cryoablation for stage 1 renal cell carcinoma with high surgical risk. World Journal of Surgical Oncology, 13, 200. (Level 2 evidence - Independent)

Zargar, H., Samarasekera, D., Khalifeh, A., Remer, E. M., O’Malley, C., Akca, O. (2015). Laparoscopic vs percutaneous cryoablation for the small renal mass: 15-year experience at a single center. Urology, 85 (4), 850-855. Abstract retrieved November 9, 2016 from PubMed database.

ORIGINAL EFFECTIVE DATE:  3/14/2008

MOST RECENT REVIEW DATE:  11/9/2017

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