Percutaneous cryoablation for perivascular hepatocellular carcinoma: Therapeutic efficacy and vascular complications

• Published in: European radiology 2019-02, Vol.29 (2), p.654-662
• Main Authors: Kim, Ran, Kang, Tae Wook, Cha, Dong Ik, Song, Kyoung Doo, Lee, Min Woo, Rhim, Hyunchul, Lim, Hyo Keun, Sinn, Dong Hyun
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Blood vessels; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - surgery; Complications; Computed tomography; Cryosurgery - adverse effects; Cryosurgery - methods; Diagnostic Radiology; Disease Progression; Female; Follow-Up Studies; Hepatocellular carcinoma; Humans; Imaging; Infarction; Internal Medicine; Interventional; Interventional Radiology; Liver; Liver cancer; Liver Neoplasms - pathology; Liver Neoplasms - surgery; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Recurrence, Local - pathology; Neuroradiology; Patients; Postoperative Complications - diagnostic imaging; Radiology; Thromboembolism; Thrombosis; Thrombosis - diagnostic imaging; Thrombosis - etiology; Tomography, X-Ray Computed; Treatment Outcome; Tumors; Ultrasound
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-018-5617-6

Objectives To evaluate the therapeutic efficacy of and vascular complications associated with percutaneous cryoablation for the treatment of perivascular HCC. Methods Between August 2015 and September 2017, 58 consecutive patients (48 men, 10 women; mean age, 61.1 years; age range, 44–84 years) who underwent percutaneous cryoablation were included. All patients had a single perivascular HCC (mean size, 1.3 cm; Barcelona clinic liver cancer-stage 0 or A) that was in contact with hepatic vessels, ≥ 3 mm or larger in axial diameter. Local tumour progression (LTP) was estimated by the Kaplan-Meier method. In addition, several procedure-related vascular complications were evaluated immediately after treatment and during follow-up CT: peritumoral vessel thrombosis; infarction; aggressive intrasegmental recurrence (AIR) (the simultaneous development of ≥ 3 nodular or infiltrative tumours). The follow-up CT was performed in all patients 1 month after the procedure, and every 3 months thereafter. Results The median follow-up period was 22 months (range, 3–29 months). The technical success rate of cryoablation was 96.6% (56/58). The 1- and 2-year cumulative LTP rates were 3.6% and 14.6%, respectively. Although peritumoral vessel thrombosis occurred in 6.9% of cases (4/58), no cases of hepatic infarction were observed and AIR did not develop during follow-up. Half of the thombi in the peritumoral vessels immediately after cryoablation disappeared on follow-up CT images. Conclusion Cryoablation could be an effective tool for the treatment of perivascular HCC with a very low risk of vascular complications. Key Points • Cryoablation allowed a high technical success rate for perivascular HCC. • Only 6.9% developed peritumoral vessel thrombosis without major vascular complications like infarction. • Two-year cumulative LTP rate was 14.6%, without aggressive tumour recurrence on follow-up.