title: Clinicopathologic effects of cryotherapy on hepatic vessels and bile ducts in a porcine model.
abstract: BACKGROUND
  The proximity of a hepatic tumor to major vessels and bile ducts limits the use of cryotherapy because of the potential damage to these structures. However, the effects of cryotherapy on major hepatic vessels and bile ducts are not well understood.
  
  
  METHODS
  Nine pigs underwent laparotomy and intraoperative ultrasound to identify hepatic vessels larger than 5.0 mm. Cryotherapy consisting of two freeze-thaw cycles was performed, incorporating the identified vessel. In four pigs the Pringle maneuver was performed to determine the effects of partial vascular occlusion on the hepatic parenchyma and structures undergoing cryotherapy. The animals were sacrificed 30 days postoperatively, and the livers were processed for histologic examination.
  
  
  RESULTS
  Eight of the nine livers had vessels larger than 5.0 mm incorporated into the iceball, with all vessels having evidence of infarction but remaining patent. All the livers had major bile ducts incorporated in the iceball, with eight having evidence of infarction. The Pringle maneuver had no real effect on the degree of vessel and bile duct infarction. There was no incidence of hepatic bleeding, liver fracture, bile leak, or hemobilia.
  
  
  CONCLUSIONS
  Cryotherapy results in the infarction of major hepatic vessels and bile ducts but can be safely performed in the porcine model. Proximity of tumors to major vascular and biliary structures may not be a contraindication to the use of cryotherapy. Further studies are necessary to determine whether cryotherapy can be used in humans.
authors.affiliation: Division of Surgical Oncology, Roswell Park Cancer Institute, State University of New York, Buffalo 14263, USA.
authors.forename: M S
authors.initials: MS
authors.lastname: Kahlenberg
authors.forename: C
authors.initials: C
authors.lastname: Volpe
authors.forename: D L
authors.initials: DL
authors.lastname: Klippenstein
authors.forename: R B
authors.initials: RB
authors.lastname: Penetrante
authors.forename: N J
authors.initials: NJ
authors.lastname: Petrelli
authors.forename: M A
authors.initials: MA
authors.lastname: Rodriguez-Bigas
mesh_terms: D000818:Animals; D001652:Bile Ducts / Q000473:pathology / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000473:pathology; D003452:Cryosurgery; D004195:Disease Models, Animal; D006503:Hepatic Veins / Q000473:pathology / Q000601:surgery*; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013552:Swine; D014463:Ultrasonography