Electrolytic liver ablation is not associated with evidence of a systemic inflammatory response syndrome.
BACKGROUND
Local ablation has been proposed for treatment of liver tumours. Cryoshock, a variant of the systemic inflammatory response syndrome (SIRS), is a potentially fatal complication of cryoablation caused by systemic release of necrotic breakdown products from ablated liver. The proinflammatory cytokines tissue necrosis factor (TNF) alpha and interleukin (IL) 1 are important mediators of this response. This study assessed the risk of SIRS complicating electrolytic liver ablation by measuring circulating levels of inflammatory cytokines, other inflammatory markers and clinical markers of organ function.


METHODS
Electrolytic liver ablation was performed in 16 pigs and four pigs served as controls. Platelet count, and serum levels of urea, creatinine, liver enzymes, C-reactive protein (CRP), TNF-alpha and IL-1beta were measured before treatment and for 72 h after the procedure.


RESULTS
There were significant dose-related increases in CRP and alanine aminotransferase levels with liver electrolysis. There was no significant derangement in renal function or platelet count following ablation. A rise in serum TNF-alpha and IL-1beta levels was not associated with liver electrolysis.


CONCLUSIONS
There was no evidence of organ failure or significantly raised levels of proinflammatory cytokines as a result of liver electrolysis, suggesting that this is a safe procedure for liver ablation.
Teague
B D
BD
University of Adelaide Department of Surgery, The Queen Elizabeth Hospital, Woodville Road, Woodville, South Australia 5011, Australia.
Court
F G
FG
Morrison
C P
CP
Kho
M
M
Wemyss-Holden
S A
SA
Maddern
G J
GJ
D000410:Alanine Transaminase / Q000378:metabolism; D000469:Alkaline Phosphatase / Q000378:metabolism; D000818:Animals; D002097:C-Reactive Protein / Q000032:analysis; D017115:Catheter Ablation / Q000379:methods*; D004572:Electrolysis / Q000379:methods*; D005260:Female; D007375:Interleukin-1 / Q000097:blood; D008099:Liver / Q000201:enzymology; D008113:Liver Neoplasms / Q000601:surgery*; D010976:Platelet Count; D012307:Risk Factors; D044967:Serum; D013552:Swine; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000201:enzymology / Q000209:etiology*; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
D007375:Interleukin-1; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase