Journal of the College of Physicians and Surgeons Pakistan
ISSN: 1022-386X (PRINT)
ISSN: 1681-7168 (ONLINE)
Affiliations
doi: 10.29271/jcpsp.2026.08.1097Sir,
Cryotherapy for many tumour types is an emerging hope with its long-term data on survival, convenience, and low cost, especially in developing countries. In recent years, it has been considered personalised and organ-sparing oncologic care, since it offers a powerful, elegant solution, frozen in time, yet brimming with transformative potential. Cryosurgery, a branch of cryobiology and surgery, involves the therapeutic application of extremely low temperatures (those below 0°C) to des-troy targeted tissues. This technique has wide-ranging surgical applications for the destruction of abnormal or diseased tissues.1
The term cryosurgery comes from the Greek words cryo, meaning icy cold, and surgery, meaning handiwork. The early medical practitioners used snow/ice for analgesic and haemostatic purposes. This shows their understanding and appre- ciation of this method. Cryosurgery or cryoablation has re- emerged in recent years as a vital component of the oncolo- gical surgical toolkit, mainly because of its minimally invasive approach to tumour management, which combines precision with cost-effectiveness and reduced morbidity.2
The modern era of cryosurgery began in the mid-19th century when James Arnott experimented by applying salt and crushed ice to breast and uterine tumours, noting a reduction in tumour mass and palliative benefits. This laid the groundwork for further experimentation.3 With the discovery of liquid nitrogen in 1883, by Polish physicists Wroblewski and Olszewski, along with cryoprobe technology, a more effective and targeted tissue freezing could be achieved. However, it remained largely underutilised due to challenges in monitoring treatment zones and controlling collateral damage.
Cryosurgery gained acceptance with the advent of real-time imaging—particularly ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI). At the cellular level, rapid freezing leads to the formation of ice crystals both inside and outside cells. These crystals disrupt cellular membranes and organelles, mechanically damaging structural integrity. Additionally, the freeze-thaw cycle creates osmotic imbalances that further compromise membrane stability, resulting in necrosis and apoptosis. Also, endothelial cells lining the microvasculature are especially susceptible to freezing, which initiates thrombus formation and vascular stasis, leading to ischaemic injury of surrounding tissues. This dual mechanism of physical cellular destruction and ischaemic necrosis ensures effective ablation of tumour masses when properly administered.4
Technological advances, especially in real-time imaging, have elevated cryosurgery from a marginal technique to a robust treatment modality. Ultrasound is used for superficial and hepatic tumours due to its convenience and cost-effectiveness. CT provides precise anatomical localisation of deeper lesions in organs such as the kidney and lungs, whereas MRI offers superior soft-tissue contrast and the ability to monitor thermal changes.
Cryosurgery has a wide range of clinical applications across several malignancies. In breast cancer, two alternating freeze– thaw cycles are used to ablate the target lesion, and the entire procedure typically takes 25–30 minutes. According to the American Society of Breast Surgeons (ASBrS) guidelines, cryoablation is approved for the treatment of fibroadeno- matous lesions; however, its use in breast cancer remains experimental.5
In prostate cancer, cryoablation offers the advantages of reduced procedural morbidity while preserving urinary and sexual function in a significant proportion of patients. For renal tumours, it provides excellent local tumour control, minimal complications, and a shorter recovery period. In hepatocellular carcinoma, cryoablation is often preferred for patients who are not suitable candidates for surgery.
Because of its minimally invasive nature, cryoablation is also emerging as an effective method for treating primary and secondary lung tumours. In dermatologic malignancies, inclu-ding basal and squamous cell carcinomas, cryoablation is being tried and may offer pain relief, structural stabilisation, and improved quality of life.
Cryosurgery offers substantial advantages in resource-limited settings in developing countries such as Pakistan. It is a cost-effective treatment that often does not require hospitalisation. As a minimally invasive procedure, it requires small or no incisions, resulting in shorter recovery times. In addition, the technique requires relatively simple training and equipment, making it feasible for use in remote areas.
The future of cryosurgery is interwoven with advances in adjacent technologies, such as synergy between cryoablation and immunotherapy. By leveraging cryo-induced tumour antigen release, researchers aim to offer more effective combination therapies that extend beyond local control to systemic eradication of micro-metastases. Its efficacy can be enhanced through nanoparticle delivery systems. Robotic assistance and image fusion techniques are poised to enhance procedural accuracy and reduce operator variability.
In conclusion, cryosurgery is witnessing a renaissance in modern oncology, evolving from a rudimentary historical practice into a sophisticated, image-guided, minimally invasive treatment moda-lity. Its unique ability to destroy tumours while preserving sur-rounding tissue and stimulating immune responses positions it at the intersection of surgical precision and systemic therapy.
COMPETING INTEREST:
The authors declared no conflict of interest.
AUTHORS’ CONTRIBUTIONS:
SB, SK: Conception, study design, analysis, and drafting of the manuscript.
Both authors approved the final version of the manuscript to be published.
REFERENCES