Kidney Cancer Cryoablation: Long-Term Results in 86 Patients

A study from MD Anderson Cancer Center in the US followed 86 patients who had percutaneous cryoablation for kidney cancer 4 cm or smaller, some for more than 13 years. It was published on October 13, 2026 in the journal Cancers. The rate of staying free of cancer at the treated site (local recurrence-free survival) was 93.5% at both 5 and 10 years, and no patient developed spread to other organs (metastasis) during follow-up.

The key point is narrow: in patients with a single, biopsy-proven kidney cancer of 4 cm or less, freezing the tumour through the skin kept it controlled for a long time. However, this is a retrospective study from one hospital, with no direct comparison with surgery, and the median follow-up was 2.7 years, so the 10-year figures are estimates based on few remaining patients.

What is new: 14 years of cryoablation records

In cryoablation, a doctor uses CT or MRI images to guide thin needles (cryoprobes) through the skin of the flank into the tumour, then freezes the needle tips to tens of degrees below zero and thaws them in repeated cycles to destroy cancer cells. The growing ice ball can be seen on imaging, so the team can check that the edges of the tumour are covered. Because the abdomen is not opened and no part of the kidney is cut out, it is a typical local treatment in IVR (interventional radiology).

The MD Anderson interventional radiology team (corresponding author Abdelsalam ME) narrowed their institutional renal ablation registry from January 2008 to December 2021 to strict criteria: a single, previously untreated kidney cancer, 4 cm or smaller (cT1a), and confirmed by biopsy. That left 86 patients. Earlier long-term cryoablation data often mixed unbiopsied masses or multiple tumours; this study isolates results for "one confirmed small kidney cancer".

Who is it for

The median age was about 69 years, with 57 men and 29 women. Notably, 58% (50 patients) also had another cancer outside the kidney. Reasons for choosing cryoablation over surgery were other illnesses making surgery risky (43%), already reduced kidney function (GFR below 60, 29%), and patient preference (7%).

• Tumour size: median 2.7 cm (1.5–4.0 cm)
• Histology: clear cell 67.4%, papillary 21%, other types for the rest
• Imaging guidance: CT in 62.8% of procedures, MRI in 37.2%

So these results come from older patients, or patients with other illnesses or cancers who wanted to preserve as much kidney as possible — not from "any healthy young patient". International guidance has similar patients in mind. The AUA advises considering thermal ablation as an alternative for solid cT1a renal masses under 3 cm, preferring a percutaneous approach when feasible, and recommends a renal mass biopsy as a separate procedure before ablation.

Results: recurrence, metastasis, survival, complications

Results from one group without a comparison arm. Figures are taken directly from Abdelsalam ME et al., Cancers 2026;18(20):3292. Complications graded by the Clavien–Dindo classification.

One distinction matters when reading these numbers. No patient died of kidney cancer, yet overall survival at 10 years was 57.1%. More than half the patients had another cancer and many were older with other illnesses; the authors also cite earlier analysis showing lower overall survival in patients with a concurrent cancer. The faithful reading is not "patients did not live long after cryoablation" but "the kidney cancer itself was well controlled, and most deaths had other causes".

All recurrences appeared more than 6 months after treatment, the latest local recurrence at about two years. New tumours elsewhere in the same kidney were found as late as about seven years. This is why regular CT or MRI follow-up for several years is needed after cryoablation.

How it differs from partial nephrectomy and surveillance

The standard treatment for small kidney cancer is still partial nephrectomy, removing only part of the kidney, now often done robotically. Cryoablation is an alternative, and for very small tumours around 2 cm, active surveillance without treatment is also an option. A 2025 cost analysis from Okayama University in Japan shows how the two approaches differ in real practice.

Japanese figures from Uka et al., International Journal of Clinical Oncology 2025;30:1621–1630. The difference in major complications (1.4% vs 3.4%) was not statistically significant.

In short, cryoablation offers faster recovery and a lighter burden on the body, but it may need re-treatment and comes with long-term imaging follow-up. In the MD Anderson study, 3 of 5 patients with local recurrence were ablated again. Kidney function preservation was not reported numerically in this paper. The principle of radiofrequency, a related thermal ablation method, is explained on our RFA (radiofrequency ablation) guide.

Where it is available and approval status

Coverage conditions and actual costs vary by country, hospital and insurance type. International patients are often not covered by the host country's public insurance, so check in advance.

When looking abroad, first check whether the hospital uses cryoablation, radiofrequency or microwave, whether the procedure is done by interventional radiology or urology, and when the biopsy is done. Some hospitals, as in this study, use MRI rather than CT guidance.

Limitations and what patients should check

• No comparison group: it was not compared side by side with surgery or surveillance, so it cannot show it is "equal to surgery".
• One hospital, 86 patients: results from an experienced cancer centre may not transfer directly to other hospitals.
• Retrospective: past records were collected, so patient selection may be biased.
• Short median follow-up: median 2.7 years, mean 3.7 years. The authors themselves say the 10-year figures should be interpreted with caution.
• Missing data: kidney function change before and after treatment, and results for tumours over 3 cm alone, were not reported.

Questions to ask your doctor:

• Has my tumour been confirmed as cancer by biopsy? If not, will a separate biopsy be done before cryoablation?
• Given the size and location of my tumour (distance from vessels, ureter and bowel), which is suitable — cryoablation, radiofrequency or partial nephrectomy — and why?
• How many kidney cryoablations does this hospital perform, and what is its experience with complications such as bleeding?
• If it recurs, can it be ablated again, or would I switch to surgery?
• When and for how many years will I have CT or MRI after the procedure? How will kidney function be checked?

To prepare for a consultation, see five questions before an RFA consultation, and for reading study numbers, how to check the study stage of overseas papers.

FAQ

Is kidney cancer cryoablation as effective as surgery?

This study did not compare it with surgery, so it cannot answer directly. Among 86 patients with biopsy-proven kidney cancer of 4 cm or less, 5 (5.8%) had recurrence at the treated site, local recurrence-free survival was 93.5% at 5 and 10 years, and none had metastasis. The AUA advises considering it as an alternative for tumours under 3 cm.

What are the side effects of cryoablation?

In this study, 4 patients (4.6%) had major complications, mostly bleeding around the kidney stopped by embolisation. One patient had blood in the urine and a blocked ureter requiring a stent and ICU care. In data from one Japanese centre, major complications occurred in 1.4%.

What happens if cancer recurs after cryoablation?

In this study, 3 of the 5 patients with recurrence at the treated site were re-treated with radiofrequency ablation and 2 were observed. All recurrences appeared after 6 months, so regular imaging for several years after the procedure is important.

Can tumours larger than 4 cm be treated with cryoablation?

This study and the US guideline recommendation focus on tumours of 4 cm or less, particularly under 3 cm. Larger tumours carry more recurrence risk and may need more needles at higher cost, so options including surgery should be discussed carefully.

This article summarises papers and public information as general information, not medical advice. Discuss treatment choices with the doctors who examine you in person.