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

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Abstract

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.

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Abbreviations

BCLC:

Barcelona clinic liver cancer-stage

CI:

Confidence interval

CT:

Computed tomography

HCC:

Hepatocellular carcinoma

LTP:

Local tumour progression

MR:

Magnetic resonance

RF:

Radiofrequency

TACE:

Transarterial chemoembolisation

US:

Ultrasound

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

    Ran Kim, Tae Wook Kang, Dong Ik Cha, Kyoung Doo Song, Min Woo Lee, Hyunchul Rhim & Hyo Keun Lim

  2. Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University School of Medicine, Seoul, Korea

    Hyo Keun Lim

  3. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

    Dong Hyun Sinn

Authors
  1. Ran Kim
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  2. Tae Wook Kang
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  3. Dong Ik Cha
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  4. Kyoung Doo Song
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  5. Min Woo Lee
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Corresponding author

Correspondence to Tae Wook Kang.

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Guarantor

The scientific guarantor of this publication is Won Jae Lee.

Conflict of interest

The authors of this paper declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Observational

• Performed at one institution

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Kim, R., Kang, T.W., Cha, D.I. et al. Percutaneous cryoablation for perivascular hepatocellular carcinoma: Therapeutic efficacy and vascular complications. Eur Radiol 29, 654–662 (2019). https://doi.org/10.1007/s00330-018-5617-6

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  • DOI: https://doi.org/10.1007/s00330-018-5617-6

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