Anaesthetic Experience with Cryotherapy for Treatment of Hepatic Malignancy

Abstract

Hepatic cryotherapy is a relatively new technique, currently employed in the treatment of unresectable liver malignancy, which involves direct freezing of tumour deposits with liquid nitrogen. In a review of 26 patients undergoing this procedure, the anaesthetic considerations are defined. The total operation time ranged from 133 to 410 minutes. In spite of preventative measures, varying degrees of hypothermia occurred (range 33.7° C to 36.5° C), but no sequelae were encountered. Mean blood loss was 926 ml, and eleven patients required blood transfusion of between one and five units. There was a marked drop in platelet count associated with cryotherapy (mean fall of 123,000/mm3 by the second postoperative day). Following the procedure, fever and basal pulmonary atelectasis were common, while hypoglycaemia and renal impairment occurred on single occasions. Six patients underwent postoperative mechanical ventilation. Despite this, the mean hospital stay was under seven days.

World Survey on the Complications of Hepatic and Prostate Cryotherapy

“…It may be related to cracking of the iceball [11,[25][26][27][28]; and in our experience it was related to incomplete thaw of the cryolesion before the abdomen is closed, resulting in hemorrhage from unnoticed cracks postoperatively.…”

Palliation of pancreatic cancer using electrolytic ablation

“…Conversely, thermal methods of ablation may cause a direct burn to large vessels. Indeed, cryotherapy has been shown to damage large veins due to cracking of the ''ice-ball'' during the freezing phase of the process [8,17]. It is proposed that the ability of electrolysis to treat tumors directly adjacent to large veins may confer a benefit when compared to other forms of ablation for debulking tumors of the pancreas.…”

Anästhesiologisches Management bei Leberresektion und Kryochirurgie der Leber

“…B. Blutung, Thrombopenie, Myoglobinurie, akute Niereninsuffizienz, Kälteschäden an der Lunge und Pleuraergüsse. Deshalb ist ein besonderes Augenmerk auf die Gerinnung und die Nieren-und Lungenfunktion zu richten (Tabelle 1; [16]). …”

“…Folgende unerwünschte Reaktionen kommen seltener vor: Blutung, akute Niereninsuffizienz, Kälteschäden der Haut, der Lunge oder anderer Gewebe, disseminierte, intravasale Gerinnung, verlängerte Prothrombinzeit, Hypoglykämie. Myoglobinämie und Myoglobinurie entwickeln sich in der Regel erst nach dem Eingriff und können eine akute Tubulusnekrose verursachen [16]. …”