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Cryoablation Provides Superior Local Control of Primary Hepatocellular Carcinomas of >2 cm Compared with Radiofrequency Ablation and Microwave Coagulation Therapy: An Underestimated Tool in the Toolbox

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Although cryoablation (Cryo) has been advocated as an effective locoregional therapy for hepatocellular carcinoma (HCC), few studies have compared the outcomes with those of radiofrequency ablation (RFA) and microwave coagulation therapy (MCT).

Methods

Consecutive patients with primary HCCs of <5 cm received Cryo or RFA/MCT between 1998 and 2011 and were monitored for local recurrence (defined as a recurrent tumor at or in direct contact with the ablated area) and overall complication rates.

Results

The median tumor size was 2.5 cm in the Cryo group (n = 55) and 1.9 cm in the RFA/MCT group (n = 64; P < 0.001), but other patient characteristics were similar. Multivariate Cox regression analysis revealed Cryo as the only independent factor for improved 2-year local recurrence-free survival, with a hazard ratio (HR) of 0.3 (95 % confidence interval, 0.1–0.9; P = 0.02). Tumor diameter was a negative indicator of local recurrence-free survival (HR, 2.0; 95 % confidence interval, 1.1–3.5; P = 0.02). Subgroup analysis of patients with tumors of >2 cm demonstrated significantly better local recurrence rates in the Cryo group compared with the RFA/MCT group (21 vs. 56 % at 2 years; P = 0.006). Overall complication rates and incidences of Clavien–Dindo classification grade ≥III were identical (both P = 1.00). No in-hospital mortality occurred.

Conclusions

Appropriate use of Cryo, as shown in this series, is safe and provides significantly improved local control for the treatment of primary HCCs of >2 cm compared with RFA/MCT.

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Conflicts of interest

Shigenori Ei, Taizo Hibi, Minoru Tanabe, Osamu Itano, Masahiro Shinoda, Minoru Kitago, Yuta Abe, Hiroshi Yagi, Koji Okabayashi, Daisuke Sugiyama, Go Wakabayashi, and Yuko Kitagawa declare that they have no conflicts of interest to disclose.

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Authors and Affiliations

  1. Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan

    Shigenori Ei MD, Taizo Hibi MD, PhD, Osamu Itano MD, PhD, Masahiro Shinoda MD, PhD, Minoru Kitago MD, PhD, Yuta Abe MD, PhD, Hiroshi Yagi MD, PhD, Koji Okabayashi MD, PhD & Yuko Kitagawa MD, PhD

  2. Department of Hepato-Biliary-Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan

    Minoru Tanabe MD, PhD

  3. Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan

    Daisuke Sugiyama MD, PhD

  4. Department of Surgery, Iwate Medical University, Iwate, Japan

    Go Wakabayashi MD, PhD

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  1. Shigenori Ei MD
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  2. Taizo Hibi MD, PhD
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Corresponding author

Correspondence to Taizo Hibi MD, PhD.

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10434_2014_4114_MOESM1_ESM.tiff

Supplementary Figure. A 3.5-cm hepatocellular carcinoma (white arrow) located in left medial section (Couinaud segment 4) in close proximity to the umbilical portion and hepatic hilum before (a) and after (b) cryoablation (TIFF 1521 kb)

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Ei, S., Hibi, T., Tanabe, M. et al. Cryoablation Provides Superior Local Control of Primary Hepatocellular Carcinomas of >2 cm Compared with Radiofrequency Ablation and Microwave Coagulation Therapy: An Underestimated Tool in the Toolbox. Ann Surg Oncol 22, 1294–1300 (2015). https://doi.org/10.1245/s10434-014-4114-7

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  • DOI: https://doi.org/10.1245/s10434-014-4114-7

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