Name of the Procedure:

Ablation, 1 or more liver tumor(s), percutaneous, cryoablation
Common name(s): Liver tumor cryoablation, Cryosurgery for liver tumors
Technical or medical terms: Percutaneous cryoablation of hepatic tumors

Summary

Cryoablation is a minimally invasive procedure used to treat liver tumors by freezing and destroying cancerous cells. It involves inserting a thin needle through the skin to apply extreme cold directly to the tumors.

Purpose

Cryoablation is used to treat liver tumors, including primary liver cancer and metastatic cancers that have spread to the liver. The goals are to eliminate the tumor cells, reduce symptoms, and potentially extend life expectancy.

Indications

• Small liver tumors not suitable for surgical removal
• Patients who cannot undergo surgery due to medical conditions
• Tumors that have recurred after previous treatments
• Symptomatic relief from tumor-related issues like pain

Preparation

• Fasting for several hours before the procedure
• Adjusting or stopping certain medications, such as blood thinners
• Pre-procedure imaging tests like CT scans or MRIs for precise tumor localization
• Blood tests to assess liver function and clotting status

Procedure Description

1. The patient is positioned on an imaging table.
2. Anesthesia is administered (usually local anesthesia with sedation or general anesthesia).
3. Using imaging guidance (CT or ultrasound), a cryoprobe is inserted through the skin directly into the liver tumor.
4. Liquid nitrogen or argon gas within the cryoprobe generates extreme cold, freezing the tumor tissue.
5. The freezing-thawing cycle is repeated as necessary to ensure complete ablation.
6. The cryoprobe is removed, and the puncture site is bandaged.

Duration

The procedure usually takes 1 to 2 hours, depending on the number and size of tumors treated.

Setting

Cryoablation is typically performed in a hospital's interventional radiology suite or an outpatient surgical center.

Personnel

• Interventional radiologist or surgeon
• Nursing staff
• Anesthesiologist or nurse anesthetist

Risks and Complications

• Common: Bleeding, infection at the puncture site, bruising
• Rare: Injury to surrounding structures (e.g., bile ducts), liver dysfunction, cryoshock (systemic reaction to freezing)

Benefits

• Minimally invasive with quicker recovery compared to open surgery
• Effective in reducing or eliminating tumor burden
• Can provide symptomatic relief
• Can be repeated if new tumors develop

Recovery

• Monitoring in a recovery area for a few hours post-procedure
• Pain management with prescribed medications
• Instructions to avoid strenuous activities for a few days
• Follow-up imaging to assess the effectiveness of the procedure
• Regular follow-up appointments with the healthcare provider

Alternatives

• Surgical resection of liver tumors
• Radiofrequency ablation
• Microwave ablation
• Transarterial chemoembolization (TACE)
• Systemic chemotherapy
• Pros: Each alternative has specific indications, benefits, and risks; some may be more effective for certain tumor types or locations.
• Cons: Alternatives may involve longer recovery times, higher risks, or may not be suitable for all patients.

Patient Experience

During the procedure, the patient is sedated or asleep and should feel minimal discomfort. Post-procedure discomfort or pain at the puncture site is common but manageable with medication. Patients may experience mild swelling or bruising, but serious pain is uncommon. Overall, most patients can resume normal activities within a few days.