The use of cryoablation in treating liver tumors

Abstract

Percutaneous image-guided tumor ablation techniques have been used as an alternative method for patients with unresectable liver tumors. Although all techniques avoid morbidity and mortality of major surgery and have advantage of preserving non-tumoral liver parenchyma, cryoablation currently is the only percutaneous ablation technique allowing intraprocedural monitoring because of visibility of its ablation effect with computed tomography and MRI. Cryoablation uses extremely low temperatures to induce local tissue necrosis to treat both primary and metastatic liver tumors. This article discusses the principles of liver tumor percutaneous cryoablation, including mechanisms of tissue injury, technique, equipment, image-guidance used, patient selection criteria, clinical outcome and complications as well as current trends and future goals.

Keywords::

• cryoablation
• cryotherapy
• hepatocellular carcinoma
• image-guided
• liver tumors
• liver metastases

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• In this article, we discussed the advantages of cryoablation technique. Cryoablation has unique ability because of the visibility of its effect on cross-sectional imaging modalities, allowing intraprocedural monitoring ability, therefore the treatment of the tumors near critical structures.

• Cryoablation technique, available equipment and mechanisms of tissue injury have been reviewed. Major cryoablation equipment brands have been introduced.

• Patient selection criteria, indications, effectiveness, complications, postablation management and imaging surveillance have been discussed.

• Future research and development areas have been discussed and these efforts likely will focus on maximizing treatment efficacy, minimizing morbidity and decreasing procedure time, also building new cost-effective devices.