Systemic effects and side effects of interstitial techniques used in liver tissue.
BACKGROUND
Percutaneous ethanol injection (PEI) and cryosurgery are increasingly used for the treatment of liver malignancies. To create a safety margin and to destroy completely diffusely growing tumors, the precise destruction of healthy liver tissue is necessary. Little is known about the effects of operating on this type of tissue. This study evaluated the effects and side effects of PEI and cryosurgery when applied to normal parenchyma of the liver.


METHODS
Two groups of six minipigs each were treated with either PEI or cryosurgery to create necrosis in the liver. During and after the procedures, vital signs were monitored and necrotic areas were observed by ultrasonography. Standard and immunohistochemistry stains were made from samples of the necrosis, the liver, and the lung.


RESULTS
In the PEI group, thromboembolic complications occurred in all animals (fatality rate 50%). Hematogenous spread of hepatocytes was demonstrated by immunohistochemistry and was a cause of pulmonary embolism. In the cryosurgery group, neither specific complications nor signs of cell spillage occurred. Because of an isolating effect of blood perfusion, hepatocytes close to the portal triads were less damaged, vital cells were present in the periphery, and the necroses were smaller than the induced lesions.


CONCLUSIONS
The effect of PEI in healthy liver tissue is unpredictable. This makes the creation of a safety margin or the treatment of a diffusely infiltrating tumor impossible. PEI always introduces the risk of hematogenous cell spread. Effects of cryosurgery are less dependent on tissue qualities. In both techniques, the real extent of complete tissue destruction cannot be visualized by ultrasonography.
Brunken
C
C
Department of Surgery, University of Hamburg, Germany.
Topp
S
S
Tesch
C
C
Drüge
G
G
Malagó
M
M
Meiners
J
J
Püschel
K
K
Schäfer
H
H
Diekmann
C
C
Scholz
J
J
Nicolas
V
V
Izbicki
J R
JR
Rogiers
X
X
D000818:Animals; D003452:Cryosurgery / Q000009:adverse effects; D000431:Ethanol / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood; D006439:Hemodynamics / Q000187:drug effects*; D007267:Injections / Q000009:adverse effects*; D008099:Liver / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology* / Q000601:surgery; D009336:Necrosis; D013552:Swine; D013556:Swine, Miniature; D013923:Thromboembolism / Q000209:etiology; D014463:Ultrasonography
D000431:Ethanol