title: The extent of cryosurgery increases the complication rate after hepatic cryoablation.
abstract: Although there have been many reports on the use of cryosurgery to ablate hepatic malignancies none have specifically examined the relationship of complication rates to the extent of cryoablation. A retrospective review from January 1997 to May 2002 identified 98 patients treated with hepatic cryotherapy. The extent of the cryosurgery was determined by the total number of lesions (TNL) and total estimated area (TEA) of the lesions from preoperative evaluation by CT scan and intraoperative evaluation by ultrasound. The major complication rate was 11 per cent. The 30-day mortality was 0 per cent, but the late procedure-related mortality was 2 per cent. Increasing the extent of cryotherapy measured by intraoperative ultrasound demonstrated significant increases in the complication rate and length of stay (LOS). With cryoablation of TEA > or = 30 cm2 there was a significant increase in the overall complication rate (56% vs 23%; P = 0.003) and LOS (8.8 +/- 6.9 vs 6.1 +/- 4.2; P = 0.022) compared with TEA < 30 cm2. Performance of concurrent procedures also led to a significant increase in complications (69% vs 29%; P = 0.010) and LOS (8.6 +/- 6.8 vs 6.0 +/- 4.0; P = 0.019). Multivariate analysis, however, showed intraoperative TEA > or = 30 cm2 to be the most significant independent predictor of increased complications and prolonged LOS.
authors.affiliation: Department of Surgery, Wayne State University, Harper University Hospital, Detroit, Michigan 48201, USA.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Sohn
authors.forename: Arthur M
authors.initials: AM
authors.lastname: Carlin
authors.forename: Christopher
authors.initials: C
authors.lastname: Steffes
authors.forename: James G
authors.initials: JG
authors.lastname: Tyburski
authors.forename: Robert F
authors.initials: RF
authors.lastname: Wilson
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Littrup
authors.forename: Donald W
authors.initials: DW
authors.lastname: Weaver
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003452:Cryosurgery / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies