Peter John Littrup MD, Abstract Co-Author: Founder, CryoMedix, LLC Research Grant, Galil Medical Ltd Research Grant, Endo Health Solutions Inc Officer, Delphinus Medical Technologies, Inc

Hussein D. Aoun MD, Abstract Co-Author: Nothing to Disclose

Barbara A. Adam MSN, Abstract Co-Author: Nothing to Disclose

Evan N. Fletcher MS, BA, Abstract Co-Author: Nothing to Disclose

Brian Faustino Baigorri MD, Abstract Co-Author: Nothing to Disclose

Mohamed M. Jaber MD, Abstract Co-Author: Nothing to Disclose

Mark J. Krycia BS, Abstract Co-Author: Nothing to Disclose

Matthew Prus BS, Abstract Co-Author: Nothing to Disclose

Fatima Memon MD, Presenter: Nothing to Disclose

To assess complication factors for liver cryoablation in relation to tumor/ablation volume and vessel proximity, in primary hepatocellular carcinoma (HCC) and metastatic tumors. Focus upon hematologic complications was also assessed for single vs. multiple tumors per procedure.

CT and/or CT-US fluoroscopic-guided percutaneous cryoablations were performed in 292 procedures on 393 tumors (66 HCC and 327 metastatic carcinomas) in 186 patients. Tumor ablation zones were measured in 3 planes and location noted according to vessel proximity. There were 179 tumors that were targeted in the same procedure and outcomes noted separately. Complications were graded by the National Institutes of Health, Common Terminology of Complications and Adverse Events (CTCAE). Patients received CT or MRI at 1, 3, 6, 12, 18, 24 months and yearly thereafter.

Results: All patients required only conscious sedation. Ablation zones and tumors averaged 5.2 and 2.9 cm, respectively. Grade >3 complications were associated with larger tumor size, for 21.5% (15/70) >4cm vs. 5% (11/222) ≤4cm for (p<.00001). Major types of complications included 12 hemoglobin (CTCAE 3), 13 platelet (2 grade 3, 8 grade 4, 3 grade 5), 1 ARDS (CTCAE 5), 4 pleural effusion (CTCAE 3), and 3 hematomas and 1 pneumothorax (CTCAE 3). In HCC patients with a pre-procedure platelet count <75,000/uL or Hb <10g/dL, major complications were significantly greater at 33% (4/12) vs. 2.4%(1/42) in patients with starting hematologic values above these levels (p<0.005). No significant difference in major complications was noted between single tumor ablation (9.0%, 20/221) compared to the multiple tumor ablation group (8.5%, 6/71; p>0.05) when controlling for total ablation volume. Re-grading according to Clavien-Dindo system lowered rate of major complications.

Major complication rate was significantly higher for larger tumors, but there was no significant difference based on location or treatment of multiple tumors when controlling for total ablation volume. HCC patients with low platelets and anemia should be avoided.

Major complication rate was significantly higher for larger tumors, but there was no significant difference based on location or treatment of multiple tumors when controlling for total ablation volume.

Littrup, P, Aoun, H, Adam, B, Fletcher, E, Baigorri, B, Jaber, M, Krycia, M, Prus, M, Memon, F, Liver Cryoablation: Safe Outcomes when Limiting Ablation Size per Session.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14018684.html