Abstract
Purpose Percutaneous cryoablation of hepatocellular carcinoma (HCC) was performed with the intention of comparing our experience with published outcomes for radiofrequency ablation (RFA). We hypothesized that our target recurrence rate for cryoablation would be equivalent or superior to RFA due to precise visualization of margins (iceball) during ablation. Materials and Methods Cryoablation was used to treat 35 lesions in 27 patients with HCC limited to the liver. An average of 2.7 cryoprobes (range 1-5) achieved an estimated margin of at least 0.5 cm after two 10 minute freeze-thaw cycles to -40°C. Initial patient and tumor characteristics, initial blood tests, treatment complications, tumor response and time to tumor failure, transplant or death were evaluated. Results Response was evaluable in 23 patients. Complete response rate was 90.3% after initial treatment and 96.8% after one additional ablation for missed margin in 2 patients. There were no subsequent recurrences in any target lesion. Median follow-up for all patients is 678 days (range 15-1388). Four patients died within 54 days: 2 following intraperitoneal hemorrhage controlled with transarterial embolization, 1 from ischemic liver injury following a TIPS for hydrothorax, and 1 resulting from extra-hepatic abscess. Two patients had recurrent tumor near the ablation tract. Three additional patients had peritoneal hemorrhage not requiring treatment. Risk of bleeding was associated with ascites (P = 0.0129) and albumin level (P=0.0177). Conclusion While excellent tumor control was achieved with cryoablation, morbidity and mortality limit use of cryoablation without technique and equipment modification to avoid hemorrhage and needle tract contamination with tumor.
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