1. History of Cryosurgery - Semantic ScholarCryosurgery, also referred to as cryotherapy or...

1. History of Cryosurgery

Kecheng Xu

Abstract

• Cryosurgery is an old as well as new technique, and has gone

through a long-term process of development. The history of “mod-

ern” cryosurgery is relatively short and is closely intertwined with

developments in low-temperature physics, engineering, and instru-

mentation that were made during the last century.

• The cryosurgical probes developed in the 1960s allow precise appli-

cation of cryosurgical treatment deep in the body. This unique ability

makes cryosurgery very promising and has resulted in the expansion

of the method during this era. Cryosurgery had mainly been applied

to uterine tumors and neurologic, orthopedic, and skin diseases.

• From the end of the 20th century, the development of imaging tech-

niques and new freezing equipment has culminated in the creation of

modern cryosurgery. The liquid nitrogen operative system and the

argon–helium surgical system represent two important stages of

modern cryosurgery.

• Now cryosurgery has been successfully used for treatment of a vari-

ety of tumors, which include benign and malignant neoplasms of the

prostate, lung, liver, pancreas, kidney, breast, uterus, ovary, bone,

and soft tissue.

Introduction

Cryosurgery, also referred to as cryotherapy or cryoablation, employs verylow temperatures to destroy diseased tissues, and has gone through a long-term process of development (Table 1.1). It is an old technique, because theuse of cold for therapeutic effect has been known since ancient history, and

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Table 1.1. History of cryosurgery.

Time (years) Inventor Cryogens Application

3500 years Old Greece Ice Treatment of infectedago wounds

11th century Avicenne Ice Anesthesia1650 Whenry Ice Treatment of gout1845 Faraday M. Ice and salt water Freezing tumors1851 Arnott Mixture of salt and Freezing advanced cancers

crushed ice1877 Caillete, France; Liquid oxygen and Making low-temperature

Pietet, Switzerland nitrogen1892 Dewar, UK Development of the

first vacuum flaskfor facilitated storageand handling of liquefied gases

1899 Campbell White First to use refrigerantsfor medical practice

1895 Linde, Germany; Use of the Joule–ThomsonHampson, UK effect to produce

continuously operatingair liquefiers

1907 Whitehouse Use of liquid air forepitheliomata

1907 Pussey William Solid carbon dioxide Establishment of cryotherapy

1911 Hall-Edwards Described carbon dioxidecollection model

1940s Kapitsa, Collins Liquid hydrogen and Making liquid nitrogennitrogen

1945 Jarnott Low temperature Treatment of tumors1950 Allington Liquid nitrogen Use of treatment in

dermatology and gynecology

1959 Mixture of ethanol Cryosurgery 1961 Cooper, USA Liquid nitrogen Treatment of diseases

of central nervous system

(Continued )



History of Cryosurgery 5

Table 1.1. (Continued )

Time (years) Inventor Cryogens Application

1967 Amoils Liquid nitrogen probe Cryoextraction1968 Liquid nitrogen Treatment of prostate

cancer and liver cancer1976 Wright Nitrous oxide Treatment of benign

cryo-apparent prostate hyperplasia1985 Zacarian Developing copper probe Treatment of deep lesions1990s USA, China Liquid nitrogen Treatment of tumors

of prostate, liver and kidney

1998 USA Argon-based cryosurgical Treatment of prostatesystem cancer and liver cancer

approved by FDA, USA1999–2000 Israel Argon-based cryosurgical Clinical use approved by

system CE, 1999, and by FDA, USA, 2000

After 2000 USA, China Argon-based cryosurgical Treatment of tumors of system liver, lung, kidney and

pancreas

it is a new option as well, because the practical use of cold for therapeuticpurposes was carried out during the last century [Zonnevylle, 1981; Gage,1998]. Today’s cryosurgery is experiencing greater international attentionand dissemination, and has become an important clinical technique mainlyfor the treatment of malignant and benign tumors [Gage, 1998].

Ancient times: treatment of infected wounds

The ancient Egyptians, and later Hippocrates, were aware of the analgesicand anti-inflammatory properties of cold, and with it they treated infectionlesions of the chest, fractures of the skull, and various battle injuries(Figure 1.1) [Zonnevylle, 1981].

Mid–19th century: use of a mixture of salt and ice

James Arnott [1851] (1797–1883) (Figure 1.2), an English physician, wasthe first person to use extreme cold locally for the destruction of tissue. In


1845, he described the use of iced-salt solutions (about –20°C) to freezeadvanced cancers in accessible sites, resulting in reduction in tumor volumeand amelioration of pain and local hemorrhage [Bird, 1949]. The cancerstreated by Arnott using the freezing technique included breast cancer, uter-ine cancer, and some skin cancers. Although palliation was the main aim, herecognized the potential of cold for curing cancer. He advocated cold treat-ment for acne, neuralgia, and headaches, achieving a temperature of –24°C.In addition, he recognized the analgesic “benumbing” effect of cold, rec-ommending the use of cold to anesthetize skin before operation. Hiscontribution to the development of cryosurgery was crucial. A piece ofequipment designed by Arnott consisted of a waterproof cushion applied to


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Figure 1.1. A man self-administering hydrotherapy (Wellcome Library, London).


the skin, two long flexible tubes to convey water to and from the affectedpart, a reservoir for the ice/water mixture, and a sump. The equipment wasexhibited at the Great Exhibition of London in 1851 and Arnott won a prizefor his effort [Bird and Arnott, 1949].

Late 19th century: use of liquid air

In the late 1800s, a new type of freezing agent, liquefying gases, had beendeveloped along with tremendous scientific advances. On Christmas Eveof 1877, Cailletet [1878] demonstrated at the French Academy of Sciencethat oxygen and carbon monoxide could be liquefied under high pressure.In the following year, 1878, Pictet [1878] also demonstrated the liquefac-tion of oxygen, but used a mechanical refrigeration cascade. In 1895, itwas the first time that Carl von Linde succeeded in liquefying air by com-pressing it and then letting it expand rapidly, thereby cooling it, and sothat produced commercial liquid air, which promoted its widespread use.

Campbell White [1899, 1901], a physician of New York, was the first person to employ refrigerants for clinical use. He reported the use ofliquid air for the treatment of different diseases, including lupus



Figure 1.2. Dr. James Arnott.


erythematosus, herpes zoster, chancroid, nevi, warts, varicose leg ulcers,carbuncles, and epitheliomas, in 1899. He showed the efficacy of liquidair in the treatment of carcinoma, and enthusiastically stated: “I can trulysay today that I believe that epithelioma, treated early in its existence byliquid air, will always be cured.”

Whitehouse [1907] reviewed the effects of liquid air on normal skin,and stated that liquid air “outranks some of the remedies on which we haveplaced great reliance.” He demonstrated that cryogen was especially usefulfor epitheliomata, lupus erythematosus, and vascular nevi. For the recur-rence of epithelioma after radiotherapy, he showed liquid air to be moresuccessful than repeat radiotherapy. During this period, there were otherscholars interested in the clinical use of cryogen as well. Bowen and Towle[1907] reported the successful use of liquid air for vascular lesions in 1907.

Early 20th century: carbonic acid snow

The debate on the best cryogen to use persisted during the early 20th cen-tury [Bracco, 1990]. In 1910, Gold [1910] showed that liquid air was farpreferable. In 1929, Irvine and Turnacliffe [1929] similarly favored liquidair and oxygen over carbon dioxide snow, and reported liquid air treat-ment of seborrheic keratoses, senile keratoses, lichen simplex, poison ivydermatitis, and herpes zoster. They found liquid oxygen very useful forwarts, declaring that “it offers a practically sure, quick and painlessmethod for removal of all types of warts, including the plantar type.”

However, an important fact is that liquid air was very difficult toobtain, limiting its wide use. In the 1920s, carbon dioxide snow (or car-bonic acid snow) had been developed. The freezing agent was easy toobtain. The liquid carbon dioxide gas was supplied in steel cylindersunder pressure. When the gas was allowed to escape, rapid expansioncaused a fall in temperature (the Joule–Thompson effect) and a fine snowwas formed. The snow was easily compressed into various shapes, knownas pencils, suitable for different treatments.

In 1935, William Pusey [1935], a doctor of Chicago, first reported theuse of carbon dioxide snow for the treatment of a large black hairy nevuson a young girl’s face, successfully resulting in depigmentation of the lesion. This was one of the first demonstrations of the extraordinary


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sensitivity of melanocytes to cold. After successfully treating other nevi, warts, and lupus erythematosus, Pusey stated regarding the carbondioxide snow: “We have found a destructive application whose action canbe accurately gauged and is therefore controllable.” He recognized thelow scarring potential of cryosurgery and suggested that this was theresult of regeneration of residual epidermal cells rather than being due tocollagen’s resistance to cold.

Hall-Edwards [1913] of Birmingham, UK first reported his collectorand compressor of carbon dioxide in 1911 (Figure 1.3). In his monograph,



Figure 1.3. Hall-Edward’s carbon dioxide snow collector and compressor.


written later in 1913, he detailed the use of carbon dioxide for the treat-ment of many conditions, particularly rodent ulcers. He showed the placeof cryosurgery in relation to x-ray use. His study was a great contributionto cryosurgery. At the same time, Cranston-Low [1911], a physician in theEdinburgh skin department, also reported the use of carbon dioxide snow,showing that “thrombosis, direct injury to tissues, and the inflammatoryexudates probably all act together” to produce the effects of freezing.

In the following years, carbon dioxide snow was very successfullyused for a wide variety of benign skin conditions and remained popularuntil the 1960s. De Quervain reported the successful use of carbonic snowfor bladder papillomas and bladder cancers in 1917 [Bracco, 1990].

During that period, several devices for the use of carbon dioxide snowwere developed. For example, Campbell White designed a roller for thetreatment of erysipelas [Rubinsky, 2000]. The great advantage of liquidair was that it was easy to obtain the lower temperatures, allowing tumorsto be treated, but a disadvantage was the difficulty in obtaining and trans-porting it. Sir James Dewar solved the problems of transportation andstorage by inventing a flask made up of two walls of glass with a vacuumbetween [Gage, 1998; Rubinsky, 2000]. Even today, the containers usedfor refrigerants have much the same design.

Mid–20th century: use of liquid nitrogen

Up to the mid–20th century, liquid nitrogen was used for clinical treat-ment [Grimmett, 1961]. Allington [1950] was the first to use liquidnitrogen; he discovered that its properties were very similar to those ofliquid air and oxygen. He used a cotton swab for treating various benignlesions. But further study showed that the option was insufficient fortumor treatment due to poor heat transfer between swab and skin.

The use of liquid nitrogen constituted the beginning of moderncryosurgery. Irving S. Cooper [1963], a neurologist at New York’s SaintBarnabas Hospital, was a pioneer in cryosurgery using liquid nitrogen andmade a great contribution to this field. He designed a liquid nitrogenprobe that was capable of achieving temperatures up to –196°C. Using theprobe, he treated Parkinson’s disease and other movement disorders byfreezing the thalamus. Some previously inoperable brain tumors met with


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improvement by his therapy. An example was his treatment for nine-year-old Steve Schiavo, who suffered from dystonia, a crippling conditioncaused by a brain tumor and characterized by tremors, muscle deformities,and loss of muscle control. The patient could no longer walk, and his armshad constant tremors. Using X-rays, Cooper accurately positioned thecryosurgical probe, freezing the tumor to −10°C, and performed braincryosurgery on the boy successfully. Cooper’s work led to an explosion ofinterest in liquid nitrogen and its eventual acceptance as a standard treat-ment in many specialties [Das et al., 1998].

It is necessary to pointout Zacarian’s contribution to freezing equip-ment and clinical cryosurgery. Zacarian [1985] developed two kinds ofequipment: one was a hand-held device which allowed one-handed oper-ation with trigger-type control and permitted variations in the spraydiameter at interchangeable tips; the other was a copper probe thatallowed tissue freezing to depths of up to 7 mm. He published manypapers on cryosurgical science and practice which promoted the develop-ment of office-based practice. Because of Zacarian’s donation, the OxfordDermatology Department became the focus of cryosurgical research inBritain in the 1970s.

In 1967, Amoils [1967] reported that he had performed cataractextraction called cryoextraction successfully using a closed-loopJoule–Thomson cryosurgical probe. According to his report, the cryo-probe acted by freezing to the capsule at the point of application andfreezing the adjacent lens matter into an “ice ball” for about 3 mm aroundthe tip of the probe. This ice ball became, so to speak, an extension of theinstrument, and traction acted as if it were coming from within the lensrather than via the capsule. Hence, the capsule breakage rate was greatlyreduced to approximately half that of the forces or erysiphake [Amoilsand Thomas, 1971]. The only operative complications were accidentaltouching and sticking of the probe to the cornea or iris, which was easilyseparated by heating the probe. The author suggested that cryoextractionwas a safe and easy method for removing cataracts, especially matureones, and could to a great extent replace the forceps or erysiphake[Amoils and Thomas, 1971]. This system is still widely used in gynecol-ogy and ophthalmology. But cooling is slow and temperatures are not lowenough to ablate tumor.




The great advances in knowledge of the biological effects on freezinghave been made in the past half-century. Almost all researches have con-cerned the effects of liquid nitrogen. The development of temperatureprobes that can be inserted into skin has allowed measurement of tissuetemperatures during freezing. An accurate picture of the shape and depth ofice ball formation with different lengths of freezing has been built up, allow-ing development of guidelines for freezing times [Kuflik and Gage, 1990].

Rand et al. [1969] performed a transphenoidal hypophysectomy withliquid nitrogen. Cryohypophysectomy involved placement of a cryoprobeinto the anterior lobe of the pituitary gland via the nasal vault and sphenoidsinus under x-ray control. The patient was awake under local anesthesia. In13 patients with acromegaly and elevated plasma growth hormone levels,remission was achieved. No optic nerve or extraocular motor nerve palsiesresulted and there was no mortality. The author pointed out thatcryosurgery could be repeated if growth hormone levels were loweredinsufficiently to give the desired results.

Gage [1969] treated 50 patients of oral and oropharyngeal cancers andachieved survival benefit comparable to that of excision. Chandler treated50 patients with malignant tumor of the head and neck, 32 of whom weretreated for cure. William G. Cahan [1967] of the Memorial Sloan-KetteringCancer Center, USA, pointed out that the main advantage of the cryoprobedesigned by him was that it reduced bleeding in the area of surgery. Cahan[1967] used cryosurgery to treat a cancer of the uterine cervix painlesslyand bloodlessly; the procedure was later found to be more effective for theprecancerous lesions of the cervix. Cahan also reduced a large tongue can-cer by cryosurgery, and then removed the shrunken lesion using regularsurgical techniques. Pearson [1968] showed his experience with cryother-apy of head and neck tumors.

Also, Leo Schwartz, a New York surgeon, who was an ear–nose–throatspecialist, practised cryosurgical medicine in Manhattan, during a period ofmore than 40 years, using liquid nitrogen to remove small tumors of thelarynx that were not cancerous. University of Michigan doctors WalterWork and Mansfield F. W. Smith used cryosurgery to remove noncancer-ous blood vessel tumors in the nose called angiofibromas, which can causemassive nosebleeds. They used liquid nitrogen to remove the tumors withno significant blood loss [Rubinsky, 2000].


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Though experience with cold injury and therapy was described inancient manuscripts and in experiments with frostbite in the 19th century,most current knowledge is based on investigations that began in the1940s, initially with frostbite and then with the use of freezing techniquesto preserve cells or produce local lesions for physiological investigations.Nevertheless, cryosurgery has not been as popular as expected. One of thereasons, presumably, is no proper means of monitoring the extent andprocess of freezing–thawing. Another reason may be no breakthrough ofequipment for cryosurgery [Harada et al., 2005].

Late 20th century to the present: imaging-guidedcryosurgery

Since the late 20th century, cryosurgery has undergone great develop-ment. This has resulted from a more in-depth survey of three importanttopics in cryosurgery: (a) the biochemical and biophysical mechanismsof tissue destruction during cryosurgery; (b) new freezing equipment;(c) monitoring and imaging techniques for cryosurgery [Rubinsky, 2000;Harada et al., 2005].

Regarding the freezing equipment, the liquid nitrogen operative sys-tem and the argon–helium operative system are the representatives of twoimportant stages of modern cryosurgery. In the mid-1990s, the next-generation multiprobe high-pressure argon–helium system wasintroduced [Almeido Gongalves, 1986; Hunsaker et al., 1985; Meijeret al., 1999]. This generation of cryosurgery machine utilizes theJoule–Thomson effect, in which different gases undergo unique tempera-ture changes when depressurized, according to unique gas coefficients.The properties of argon make it useful for cooling to below –180°C,whereas helium is ideal for thawing and rewarming. The use of gas allowsrapid transition from freezing to defrosting, which facilitates tighter con-trol as well as expedition of the procedure. Further improvements intechnology include a significant reduction in the probe diameter. Ultrathinprobes with sharp tips now allow direct percutaneous probe placement.

Another technological advance which has caused renewed interest incryosurgery is the development of intraoperative ultrasound to monitorthe therapeutic process. The manner of use is to place the probe at the




desired location in the diseased tissue under ultrasound, CT, or MRI guid-ance. If required by the size or location of the tumor, multiple probes canbe inserted and cooled to –160°C simultaneously [Harada et al., 2005].

Clinical applications of cryosurgery have become common in the past10 years. The cases selected for cryosurgery are generally those for whichno conventional treatment is possible. However, especially in prostaticcancer, the cryosurgical morbidity is very low and the results of therapyare sufficiently good in the short term to merit consideration for use inearlier stages of the disease. Diseases which are adaptable to cryosurgeryinclude not only prostatic cancer and liver tumors, but also diverse tumorsin other sites, such as the lung, brain, breast, bone, pancreas, kidney, anduterus [Xu et al., 2007].

During that period, large amounts of experimental and clinical researcheshave emerged. More than 16 international conferences of cryosurgery havebeen convened by the International Society of Cryosurgery. The magazineCryobiology has published 60 volumes. Approximately 20,000 papers withrelevant information on cryosurgery for cancer have appeared in a variety ofacademic magazines, according to an online PubMed search using thekeywords “cryosurgery,” “cryoablation,” “cryotherapy,” and “cancer.”

The monograph Basics of Cryosurgery, edited by Nikolai Korpan in2001, has comprehensively described the principle and clinical applicationof cryosurgery in a variety of tumors. In it, Dr. Korpan presents some newopinions; for example, he states: “All patients with pancreatic cancer haveresponded well to cryosurgery” and “There were no surgical complicationsor mortality directly associated with the cryosurgery” [Gonder et al.,1966]. He has also edited Cryoscience and Cryomedicine (2006) andCryoscience and Cryomedicine (2009). Other monographs includeClinical Application of Cryobiology, edited by Barry J. Fuller and B. W. W.Grout in 1991; Cutaneous Cryosurgery, edited by Rodney Dawber, ArthurJackson, and Graham Colver in 2005; Urologic Cryoablation, edited by D. B. Rukstalis and A. Katz in 2007; and Step by Step ColposcopyCryosurgery and LEEP, edited by B. Shakuntala Baliga in 2009.

In Asia, cryosurgery as a practical technique has been developed. Themonograph Percutaneous Cryotherapy of Renal Cell Carcinoma Underan Open MRI System, edited by J. Harada, K. Miyasaka, and S. Sumida ofJapan, was published in 2005. This is a pilot work which describes the


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advanced technique of cryosurgery using MR imaging guidance. Sumidaand his colleagues founded the Japanese Society for Low TemperatureMedicine in 1974, which has moderated the annual academic conferencefor 37 years up to now. In September 2010, the Preparation Committee ofthe Asian Society of Cryosurgery was founded in Guangzhou, China, withthe members including surgeons and physicians who are at work oncryosurgery from Asian countries and regions, including China, HongKong, Indonesia, Japan, and South Korea.

In China, cryosurgery for cancer has been paid great and continuedattention. In the 1990s, Zhou used open cryosurgery (liquid nitrogen) forthe treatment of a large number of hepatocellular carcinomas, with resultscomparable to that of operative resection [Zhou et al., 1988; Zhou, 1992].Since the early 21st century, cryosurgery using the argon-based cryosur-gical system has been applied at more than 100 hospitals or medicalcenters in China. More than 20,000 patients with malignant and benigntumors have received cryosurgery. It is especially noted that most cases ofcryosurgery performed in China used the percutaneous approach. Chinahas become one of the countries where cryosurgery has been popularlyused. In 2007, the 14th International Conference of Cryosurgery was heldin Beijing, China. In the same year, Cryosurgery for Cancer (in Chinese),edited by Dr. Kecheng Xu and Dr. Lizhi Niu, was published by theShanghai Science-Education Publishing House. This is the first mono-graph on the field of cryosurgery in China [Xu et al., 2007].

Many scholars have made great, historic contributions to the devel-opment of cryosurgery for tumors in recent years. Here we are honored tolist most of these scholars (according to incomplete data).

Prostate cancer cryosurgery

In the 1960s, Gonder [1966; Soanes and Gonder, 1968] was the first to reportprostate cryosurgery using a single transurethral liquid nitrogen probe to treatbladder outlet obstruction caused by benign prostatic hyperplasia andprostate cancer. In 1972, Flocks et al. [1972] modified the technique by usingan open transperineal approach with visual control of the cryoablation. In1974, Megalli et al. [1974] was the first to employ a closed perineal approachusing a single 18 F liquid nitrogen probe. Onik et al. [1991] revived interest




in prostate cryosurgery in the early 1990s, combining endourologic percuta-neous techniques with the introduction of real-time transrectal ultrasound(TRUS). In addition, improvement of thermosensors by Steed et al. [1997]in the 1990s allowed precise monitoring of the ice ball. Introduction of awarming catheter for urethral mucosa protection resulted in a significantreduction in sloughing and incontinence rates, thereby reducing morbidityand improving success rates. In the following years, Bahn et al. [2003] andCohen [2004] in the USA made significant contributions regarding technicalimprovement and increase in the efficacy of cryosurgery for prostate cancer.

Liver cryosurgery

Open cryosurgery for liver cancer

Heard [1955] was one of the first to describe the morphological appear-ance of the liver subjected to slow cooling. In the same year, Serra andBrunschwig [1955] reported numerous experimental and clinical studiesinvestigating the effects of freezing on the hepatic tissue. The first use ofcryosurgery for ablation of liver cancer was described by Cooper in 1963[Cooper, 1963]. In 1970, Stucke and Hirte [1970] of Germany publisheda clinical report on cryosurgery for liver cancer. Russian Shalimov alsodescribed cryoeffect in liver surgery in 1979 [Shalimov et al., 1979]. Zhouet al. [1988] of Shanghai, China reported experimental and clinical studyin the same year. Since then, Zhou and his colleagues [Zhou, 1992; Zhouet al., 1998, 2002] have reported largest series of open cryosurgery for thetreatment of hepatocellular carcinoma. During the past more than10 years, Gage (USA) [1982], Onik (USA) [1984], Ross (USA) [1993],Hobbs (UK) [1993], Weaver (USA) [1995], Korpan (Austria) [1997],Rivoire (France) [1997], Seifert et al. (Germany) [2002], Haddad (USA)[1998], Mala et al. (Norway) [2004], and Adam et al. (France) [1997]have published papers on open hepatic cryosurgery.

Laparoscopic cryosurgery for liver cancer

In 1997, Tandan et al. [1997] of Canada first made an experimental obser-vation of laparoscopic cryosurgery for hepatic tumors, and presented a


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report on a patient who underwent this therapy. Then, Iannitti and hiscolleagues (USA) [1998], Lezoche and his assistants (Italy) [1998], and Shimonov (Israel) [2002] reported their results of laparoscopiccryosurgery for the treatment of liver cancer.

Percutaneous cryosurgery for liver cancer

In 1998, Adam (France) [1998] first reported the treatment of irresectableliver tumors by percutaneous cryosurgery. Nakazaki [2001] of Japanreported the experience of percutaneous hepatic cryosurgery. Xu and Niu[2003, 2008a] in Guangzhou, China reported percutaneous cryosurgeryfor the treatment of hepatocellular carcinoma (in 2001) and colorectalliver metastases (in 2009), respectively.

Lung cryosurgery

Endobronchial cryosurgery for lung cancer

The main contributors to this therapy are Maiwand and Asimakopoulos of the UK, who reported endobronchial cryosurgery for more than 500patients with lung cancer during a nine-year-period in 2003 and 2004[Maiwand et al., 2004].

Open cryosurgery for lung cancer

Ping Liu [1985, 1991a,b] from China edited a monograph entitledPulmonary Cryosurgery, in which he describes the surgical results underopen thoracotomy using a lung freeze-fixation instrument for 80 patientswith pulmonary tumor. The five-year survival was 24.3% in 37 cases of pri-mary pulmonary cancer. The cryosurgery for pulmonary carcinoma by Liucould have been the first attempt in the world. Maiwand et al. (UK) [2004]published the first and only report on direct cryosurgery for lung cancer.

Percutaneous cryosurgery for lung cancer

Wang (China) [2004], Kawamura (Japan) [2006], and Niu (China) [Niuet al., 2007] sequentially reported their experience of percutaneous




cryosurgery for lung cancer. In Niu’s report, percutaneous cryosurgery forcentrally located lung cancer is encouraging [Niu et al., 2007].

Cryosurgery for pancreatic cancer

Kovach et al. (USA) [2002] reported the use of open cryosurgery for thetreatment of pancreatic cancer in 2002. Korpan (Austria) pointed out theeffectiveness and safety of cryosurgery for pancreatic cancer [2001b]. Xuand Niu (China) [2008b] first used percutaneous cryosurgery to treatlocally advanced pancreatic cancer with or without iodine-125 seedimplantation.

Cryosurgery for breast cancer

In 1997, Staren et al. (USA) [1997] proved feasible and efficacious breastcryosurgery in small and large animal studies, and reported one patientwith breast cancer who had successfully undergone the therapy. Ablin[1998] further reported the experience of breast cryoablation in the sameyear. After this, there are several specialists, such as Pfleiderer (Germany)[2002], Kaufman (USA) [2004], Sabel (USA) [2005], and Littrup (USA)[2005], who showed that percutaneous cryoablation is a feasible andpromising treatment protocol.

Renal cryosurgery

Open cryosurgery for renal cancer

In 1996, Delworth of the USA [1996] performed pioneering work of anopen cryoablation for renal cell carcinoma. Two years later, Lugnani (Italy)[1998] reported a similar result. Since then, Rukstalis (USA) [2001],Pantuck (USA) [2002], Khorsandi (USA) [2002], and Badwan (USA)[2008] have reported their experience of open cryosurgery for renal tumors.

Laparoscopic cryosurgery for renal cancer

Gills et al. [2003] made a great contribution to laparoscopic cryosurgeryfor renal tumors. Bishoff (USA) [1999], Nadler (USA) [2003], Janzen


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(USA) [2003], and Weld [2007] sequentially reported their experiences inthis field.

Percutaneous cryosurgery for renal cancer

Renal tumor cryoablation with a percutaneous approach under ultrasoundguidance was first described by Uchida (Japan) in 1995. In the followingyears, Harada (Japan) [2001], Sewell (USA) [2003], Shingleton (USA)[2003], Gore (USA) [2005], and Kodama (Kodama) [2005] also reportedthe results of percutaneous cryosurgery for the treatment of renal tumors.

Cryosurgery for uterine fibroids

The contributors to the development of cryosurgery for uterine fibroidsinclude Zreik (USA) [1998], Duleba (USA) [2003], Cowan (USA)[2004], Dohi (Japan) [2004], Zupi (Italy) [2004], etc.

Cryosurgery and immunology

Since the 1980s, Fazio (Italy) [1982], Eastham [1976], Kogel (Germany)[1985], Wang (China) [1989], and Suzuki (Japan) [1995] have attempted tocharacterize the immunologic changes in patients undergoing cryoablationof cancers. Ablin (USA) [1995] first showed the concept of cryoimmunol-ogy in 1995. Fontana (Italy) [1975], Jaeschock (Germany) [1976], Kogel(Germany) [1985], Hoffmann (USA) [2001], and Sabel (USA) [2005] havealso done important research in this field.

Cryosurgery and chemotherapy

Korpan [2001a], Mir [2002], and Baust [2004] studied the relationshipbetween cryosurgery and chemotherapy.

Conclusion

Cryosurgery is a surgical technique that employs freezing to destroy unde-sirable tissue. First developed in the middle of the 19th century, it has




recently incorporated new imaging technologies and become a fast-growingand minimally invasive surgical technique. It is anticipated that cryosurgery,especially percutaneous cryosurgery, will become a practical and effectivemodality for treatment of a variety of early and advanced cancers.

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