title: Percutaneous cryoablation of hepatic tumors: long-term experience of a large U.S. series.
abstract: To report our long-term experience with percutaneous cryotherapy for primary and metastatic liver tumors, including historical perspectives on complications over time and local recurrence rates.
  
  
  
  Following IRB approval under HIPAA compliance, 342 CT fluoroscopic-guided, percutaneous cryotherapy procedures were performed for 443 masses in 212 outpatients with hepatocellular carcinoma (HCC; N = 36), or metastatic disease (N = 176), grouped as colorectal carcinoma (CRC) and non-CRC metastases. Tumor and ablation sizes were noted in relation to adjacent vasculature. All complications were graded according to standardized criteria. Patients were followed by CT and/or MRI at 1, 3, 6, 12, 18, 24 months and yearly thereafter. Local recurrences were defined as either "procedural" within the ice ablation zone, or "satellite" within 1 cm of the ablation rim to evaluate recurrence patterns.
  
  
  
  Average tumor diameter of 2.8 cm was treated by average cryoprobe number of 4.5, which produced CT-visible ice ablation zone diameters averaging 5.2 cm. Grade >3 complications were primarily hematologic [N = 20/342; (5.8%)], and appeared related to pre-procedural anemia/thrombocytopenia, carcinoid tumor type, and large ablation volumes. No significant central biliary leak, strictures, or bilomas were noted. At a mean follow-up of 1.8 years, local tumor recurrences were 5.5%, 11.1%, and 9.4% for HCC, CRC, and non-CRC metastases, respectively, consisting mainly of satellite foci. No significant difference was noted for local recurrences near major blood vessels or tumors >3 cm diameter.
  
  
  
  Percutaneous hepatic cryotherapy is a well-visualized, safe procedure that produces very low local recurrence rates, even for tumors near vasculature and diameters over 3 cm. Cryoablation deserves to be in the armamentarium of percutaneous hepatic ablation, especially with careful patient selection for tumors <4 cm and patients with platelet counts >100,000. Percutaneous hepatic cryoablation represents a highly flexible technique with particular benefits near central biliary structures and/or adjacent crucial structures.
authors.affiliation: Rhode Island Medical Imaging, Rhode Island Hospital, Brown University, Providence, RI, USA. plittrup@lifespan.org.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Littrup
authors.affiliation: Karmanos Cancer Institute, 110 East Warren, Hudson-Weber Building, Suite 504, Detroit, MI, 48201, USA.
authors.forename: Hussein D
authors.initials: HD
authors.lastname: Aoun
authors.affiliation: Karmanos Cancer Institute, 110 East Warren, Hudson-Weber Building, Suite 504, Detroit, MI, 48201, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Adam
authors.affiliation: Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Krycia
authors.affiliation: Karmanos Cancer Institute, 110 East Warren, Hudson-Weber Building, Suite 504, Detroit, MI, 48201, USA.
authors.forename: Matt
authors.initials: M
authors.lastname: Prus
authors.affiliation: Karmanos Cancer Institute, 110 East Warren, Hudson-Weber Building, Suite 504, Detroit, MI, 48201, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Shields
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D003452:Cryosurgery / Q000379:methods*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014481:United States
keywords: Complication; Cryoablation; Hepatocellular carcinoma; Liver tumors; Metastases; Recurrence