Cryoablation induces greater inflammatory and coagulative responses than radiofrequency ablation or laser induced thermotherapy in a rat liver model.
BACKGROUND
Cryoablation (CA), radiofrequency ablation (RFA), and laser induced thermotherapy (LITT) are alternative therapies for patients with unresectable liver tumors. We investigated whether there are different inflammatory and coagulative responses between these techniques.


METHODS
Livers of 48 rats were subjected to either CA, RFA, LITT, or sham operation (n = 12 in each group). Blood was withdrawn before, and 1, 3, 6, and 24 h after ablation. Liver enzymes as well as inflammatory and coagulation parameters were determined. Whole liver sections from the coagulated liver lobe were stained for quantification of necrosis and morphologic examination.


RESULTS
Histologic examination showed similar volume of complete destruction of liver parenchyma after CA, RFA, or LITT. Transaminase levels as well as the inflammatory response upon CA, as reflected by white blood cell count and cytokine levels, were significantly higher than following RFA or LITT. The systemic intravascular procoagulative state in rats that underwent CA, as reflected by platelets, and levels of sensitive markers for activation of coagulation and fibrinolyis, was also significantly higher.


CONCLUSIONS
CA of liver in rats induces greater inflammatory and coagulative responses than RFA or LITT. The combined activation of inflammation and coagulation may importantly contribute to the higher morbidity after CA.
Jansen
Maarten C
MC
Department of Surgery (Surgical Laboratory), Academic Medical Centre, Amsterdam, The Netherlands.
van Hillegersberg
Richard
R
Schoots
Ivo G
IG
Levi
Marcel
M
Beek
Johan F
JF
Crezee
Hans
H
van Gulik
Thomas M
TM
D000410:Alanine Transaminase / Q000097:blood; D000818:Animals; D001219:Aspartate Aminotransferases / Q000097:blood; D001778:Blood Coagulation Disorders / Q000209:etiology* / Q000473:pathology; D001792:Blood Platelets; D001831:Body Temperature; D017115:Catheter Ablation / Q000009:adverse effects*; D003452:Cryosurgery / Q000009:adverse effects*; D005342:Fibrinolysis; D006454:Hemoglobins / Q000378:metabolism; D006505:Hepatitis / Q000209:etiology* / Q000473:pathology; D006979:Hyperthermia, Induced / Q000009:adverse effects*; D007249:Inflammation / Q000209:etiology / Q000473:pathology; D016753:Interleukin-10 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D053685:Laser Therapy / Q000009:adverse effects*; D053844:Lasers, Solid-State; D007958:Leukocyte Count; D008099:Liver / Q000601:surgery; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000473:pathology; D051381:Rats; D011919:Rats, Inbred Strains
D006454:Hemoglobins; D015850:Interleukin-6; D016753:Interleukin-10; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase