Cryosurgery for Hepatic Malignancies

Gagné, Daniel J.; Roh, Mark S.

doi:10.1007/978-1-4612-1666-7_10

Cited by 10 publications

(12 citation statements)

References 76 publications

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“…Liver suturing or packing is required to control hemorrhage in most of these cases. Thrombocytopenia and consumptive coagulopathy are not uncommon after hepatic cryoablation and can be the cause of delayed hemorrhage in the treated lesion or at distant sites [29,35,37]. Thrombocytopenia or coagulopathy did not develop in any of our RFA patients.…”

Section: Greatest Diametermentioning

confidence: 63%

“…Thrombocytopenia or coagulopathy did not develop in any of our RFA patients. The complete coagulation of tumor and the surrounding hepatic microvasculature by RFA seems to prevent the rapid release of necrotic cellular products into the circulation and, thus, explains the absence in our RFA patients of myoglobinuria, tumor lysis syndrome, and renal dysfunction that has been reported after cryoablation [29][30][31]36]. An abscess has been reported to develop in the necrotic, cryoablated liver tumor in 3%-20% of the treated lesions [31,[37][38][39].…”

Section: Greatest Diametermentioning

confidence: 77%

“…Studies have demonstrated that liver tumors must be cooled to at least -35°C throughout the entire tumor to achieve a reliable tumor cell kill [28,29]. Tumor cell death is not a direct consequence of lowering tissue temperature, but rather is caused by ice crystal formation during rapid freezing with resultant destruction of normal cellular structures.…”

Section: Rfa Compared To Other Local Ablation Techniquesmentioning

confidence: 99%

“…The low temperature necessary for tumor cell destruction with cryoablation is difficult to achieve at the periphery of tumors larger than 5-6 cm in diameter, when the tumor abuts a major intrahepatic branch of the portal or hepatic veins, or if it lies near the IVC. Complications described after hepatic cryoablation include a mortality rate of 1.6%, significant intraoperative hemorrhage, cold injury in adjacent organs, biliary fistulae, coagulopathy, thrombocytopenia, myoglobinuria, acute renal failure, intrahepatic abscess in the cryolesion, and symptomatic pleural effusions [28][29][30][31]. The overall reported complication rates after cryoablation range from 15%-60%, with an average of 45% [31].…”

Section: Rfa Compared To Other Local Ablation Techniquesmentioning

confidence: 99%

“…In contrast, the mean blood loss reported during cryoablation operations is up to 750 ml, and as many as one-third of patients require blood transfusions [29,33,34]. Intraoperative hemorrhage may occur from the 3-15-mm diameter cryoprobe track or liver surface cracking during thawing of the iceball [29,[35][36][37]. Liver suturing or packing is required to control hemorrhage in most of these cases.…”

Section: Greatest Diametermentioning

confidence: 99%

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Radiofrequency Ablation of Malignant Liver Tumors

2001

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The majority of patients with primary or metastatic hepatic tumors are not candidates for resection because of tumor size, location near major intrahepatic blood vessels precluding a margin-negative resection, multifocality, or inadequate hepatic function related to coexistent cirrhosis. Radiofrequency ablation (RFA) is an evolving technology being used to treat patients with unresectable primary and metastatic hepatic cancers. RFA produces coagulative necrosis of tumor through local tissue heating. Liver tumors are treated percutaneously, laparoscopically, or during laparotomy using ultrasonography to identify tumors and guide placement of the RFA needle electrode. For tumors smaller than 2.0 cm in diameter, one or two deployments of the monopolar multiple array needle electrode are sufficient to produce complete coagulative necrosis of the tumor. However, with increasing size of the tumor, there is a concomitant increase in the number of deployments of the needle electrode and the overall time necessary to produce complete coagulative necrosis of the tumor. In general, RFA is a safe, well-tolerated, effective treatment for unresectable hepatic malignancies less than 6.0 cm in diameter. Effective treatment of larger tumors awaits the development of more powerful, larger array monopolar and bipolar RFA technologies.

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Section: Greatest Diametermentioning

confidence: 63%

Section: Greatest Diametermentioning

confidence: 77%

Section: Rfa Compared To Other Local Ablation Techniquesmentioning

confidence: 99%

Section: Rfa Compared To Other Local Ablation Techniquesmentioning

confidence: 99%

Section: Greatest Diametermentioning

confidence: 99%

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Radiofrequency Ablation of Malignant Liver Tumors

2001

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A Comparison of Percutaneous Cryosurgery and Percutaneous Radiofrequency for Unresectable Hepatic Malignancies

Adam

Hagopian²,

Linhares³

et al. 2002

Arch Surg

164

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The complication and success rates in patients treated with either percutaneous cryosurgery (PCS) or percutaneous radiofrequency (PRF) for unresectable hepatic malignancies are similar. Design: Retrospective study. Setting: University hospital. Patients and Methods: Sixty-four patients were treated with either PCS (n = 31) or PRF (n = 33). Patient treatment was based on the random availability of the probes. Tumors were evaluated by a blinded comparison of pretreatment and posttreatment helical computed tomographic scans. All living patients had at least a 6-month follow-up. Main Outcome Measures: Complication rate, initial treatment success (complete devascularization of the tumor), and local recurrence (tumor revascularization within or at its periphery). Results: The distribution of tumor types was similar in the 2 groups (P = .76). One patient with cirrhosis died of variceal hemorrhage on day 30 after PCS (mortality, 3.2%), while no mortality was observed after PRF (P=.48). Complications occurred in 9 (29%) of the patients following PCS and in 8 (24%) of the patients following PRF (P=.66). Initial treatment success was comparable in the 2 treatment groups (30 [83%] of 36 tumors following PCS vs 34 [83%] of 41 tumors following PRF). However, local recurrences occurred more frequently after PCS than after PRF (16 [53%] of 30 vs 6 [18%] of 34; P =.003). The higher rate of local recurrence was identified for metastases (10 [71%] of 14 after PCS vs 3 [19%] of 16 after PRF; P=.004), while the difference was not significant for hepatocellular carcinoma (6 [38%] of 16 after PCS vs 3 [17%] of 18 after PRF; P =.25). Multivariate analysis demonstrated that the use of PCS (P=.003) and more than 1 treatment (P=.05) were independent risk factors for local tumor recurrence. Conclusion: While similar initial treatment success and complication rates are observed following either PCS or PRF, local recurrences occur more frequently following PCS, particularly for metastases.

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Radiofrequency Ablation of Hepatocellular Carcinoma

Curley¹,

Izzo²

2004

Radiofrequency Ablation for Cancer

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Cryosurgery for Hepatic Malignancies

Cited by 10 publications

References 76 publications

Radiofrequency Ablation of Malignant Liver Tumors

Radiofrequency Ablation of Malignant Liver Tumors

A Comparison of Percutaneous Cryosurgery and Percutaneous Radiofrequency for Unresectable Hepatic Malignancies

Radiofrequency Ablation of Hepatocellular Carcinoma

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