Interleukin‐6 and Tumor Necrosis Factor‐α Levels following Hepatic Cryotherapy: Association with Volume and Duration of Freezing

Abstract

Although morbidity following cryotherapy is usually minor, a syndrome of multiorgan failure and disseminated intravascular coagulation (DIC) has been described and referred to as the cryoshock phenomenon. We hypothesized that mediators similar to those in septic shock may be involved in this syndrome. In this study we aimed to assess the plasma concentrations of the cytokines tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) following hepatic cryotherapy and to relate them to the duration and volume of freezing and to hepatocellular injury. Between April and December 1997 blood samples were taken preoperatively and at different times postoperatively from patients undergoing hepatic artery catheter-insertion (HAC) (n = 15), cryotherapy (n = 5), liver resection (n = 9), liver resection and edge cryotherapy (n = 7), or liver resection and cryotherapy of additional lesions (n = 9). They were analyzed for serum aspartate transaminase (AST) and plasma TNF-alpha and IL-6 levels. There was a significant association (Pearson correlation) of serum AST levels 1 hour postoperatively with plasma TNF-alpha and IL-6 levels at the end of the procedure. In patients undergoing cryotherapy or resection with cryotherapy of additional lesions (n = 14), the volume and duration of hepatic freezing were significantly associated with postoperative serum AST and plasma TNF-alpha and IL-6 levels at various postoperative times. Hepatic cryotherapy is followed by cytokine release, with postoperative plasma TNF-alpha and IL-6 levels associated with the degree of hepatic cryotrauma. These mediators may be involved in the occurrence of cryoshock following large-volume hepatic freezing.

Change in inflammatory cytokine profiles after transarterial chemotherapy in patients with hepatocellular carcinoma

“…Following TACE, more extensive hepatocellular damage is expected to occur in patients with large HCC, as evidenced by a higher incidence of severe hepatitis in our cases of large HCC. This extensive hepatic injury in turn results in a potentially greater release of cytokines, some of which may be protective against hepatocellular damage and promote liver regeneration [2,20]. In agreement with the previous data [20], our observation of a positive correlation between posttreatment serum aminotransferase and IL-6 levels suggests that IL-6 is released proportionally in response to the degree of hepatic damage and is involved in the initial phase of liver regeneration.…”

“…In our study, this phenomenon was more prominently observed in patients with large tumors. This may reflect the degree of hepatic trauma resulting from treatment [20]. Following TACE, more extensive hepatocellular damage is expected to occur in patients with large HCC, as evidenced by a higher incidence of severe hepatitis in our cases of large HCC.…”

Liver ablation techniques: a review

“…Biliary fistulae have been described in all series and occur in almost a third of patients (6-29%) [53]. In these series there is a direct relationship between the volume of liver ablated and the incidence of complications [54][55][56].…”

Large Volume Hepatic Microwave Ablation Elicits Fewer Pulmonary Changes than Radiofrequency or Cryotherapy

“…The resultant inflammatory response is due principally the release into the systemic circulation of significant quantities of pro-inflammatory cytokines mainly tumour necrosis factor-α, interleukin 1β (IL-1β) and interleukin 6 (IL-6). 3,[6][7][8][9] A number of studies have compared the systemic pathophysiologic and histologic responses of the different ablative techniques and compared them to hepatectomy. NF-κB activation, the production of NF-κB-mediated cytokines (TNF-α and MIP-2), histologic changes and pathophysiologic alterations of the lung perfusion have been observed after CRYO but not after RFA 1 or hepatectomy.…”