Comparison of systemic responses of radiofrequency ablation, cryotherapy, and surgical resection in a porcine liver model.
BACKGROUND
The degree of systemic response after hepatic radiofrequency ablation (RFA) has not been well investigated.


METHODS
An in vivo study was conducted on 23 domestic swine. Different hepatic procedures (RFA, cryotherapy, hepatic pedicle ligation, and hepatectomy) were performed on the medial lobe of the liver (30% of the liver volume). Systemic responses in terms of systemic inflammatory marker changes and end-organ functions were determined.


RESULTS
During the early postoperative period, the systemic inflammatory marker concentrations (tumor necrosis factor-alpha and interleukin-1beta) in the RFA group were significantly lower than in the cryotherapy group but significantly higher than in the control group. The corresponding concentrations in the hepatectomy group remained similar to those in the control group. The pattern of changes of serum inflammatory marker concentrations in the pedicle ligation group followed the pattern in the RFA group. The serum intracellular content concentrations (lactate dehydrogenase and urate) of the cryotherapy group peaked at 6 hours after operation, which was significantly later than in the other groups. Liver function, renal function, and coagulation profiles remained normal in the RFA group. However, the renal function deteriorated in the cryotherapy group on day 1. Both platelet count and activated clotting time showed significant derangement in the cryotherapy group compared with the control group. There was more severe interstitial pneumonitic change of the porcine lung after cryotherapy than after RFA.


CONCLUSIONS
The systemic responses of RFA were significantly less severe than those of cryotherapy in this porcine model. However, the increase in serum inflammatory markers and pneumonitis after RFA was substantial when compared with hepatectomy.
Ng
Kelvin K
KK
Department of Surgery, Centre for the Study of Liver Disease, University of Hong Kong, Pokfulamad, Hong Kong, China. kcng66@yahoo. com
Lam
Chi Ming
CM
Poon
Ronnie T
RT
Shek
Tony W
TW
To
Jensen Y
JY
Wo
Yim Hung
YH
Ho
David W
DW
Fan
Sheung Tat
ST
D000818:Animals; D015415:Biomarkers / Q000032:analysis; D017115:Catheter Ablation / Q000379:methods* / Q000662:veterinary; D003452:Cryosurgery / Q000379:methods* / Q000662:veterinary; D016207:Cytokines / Q000097:blood; D004195:Disease Models, Animal; D006498:Hepatectomy / Q000379:methods* / Q000662:veterinary; D007249:Inflammation; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008113:Liver Neoplasms / Q000601:surgery* / Q000662:veterinary; D013552:Swine; D016896:Treatment Outcome
D015415:Biomarkers; D016207:Cytokines; D007770:L-Lactate Dehydrogenase