Percutaneous cryoablation: a novel treatment option in non-visceral metastases of the abdominal cavity after prior surgery

Abstract

Purpose: To assess the primary safety and oncological outcome of percutaneous cryoablation in patients with non-visceral metastases of the abdominal cavity after prior surgery.

Methods: All patients with non-visceral metastases after prior abdominal surgery, treated with percutaneous cryoablation, and at least one year of follow-up were retrospectively identified. Technical success was achieved if the ice-ball had a minimum margin of 10 mm in three dimensions on the per-procedural CT images. Complications were recorded using the Society of Interventional Radiology (SIR) classification system. Time until disease progression was monitored with follow-up CT and/or MRI. Local control was defined as absence of recurrence at the site of ablation.

Results: Eleven patients underwent cryoablation for 14 non-visceral metastases (mean diameter 20 ± 9 mm). Primary tumor origin was renal cell (n = 4), colorectal (n = 3), granulosa cell (n = 2), endometrium (n = 1) and appendix (n = 1) carcinoma. Treated metastases were localized retroperitoneal (n = 8), intraperitoneal (n = 2), or in the abdominal wall (n = 4). Technical success was achieved in all procedures. After a median follow-up of 27 months (12-38 months), all patients were alive. Local control was observed in 10/14 non-visceral metastases, and the earliest local progression was detected after ten months. No major adverse events occurred. One patient suffered a minor asymptomatic adverse event.

Conclusion: This proof-of-concept study suggests that cryoablation can be a minimal invasive treatment option in a selected group of patients with non-visceral metastases in the abdominal cavity after prior surgery.

Keywords: Abdomen; Cryosurgery; Interventional Radiology; Metastases; Neoplasms.

Fig. 1

A 57-year-old female patient with a history of mucinous appendix carcinoma treated with a right hemicolectomy, two debulkings including HIPEC, and a liver metastectomy, now presents with a rise in carcinoembryonic antigen (CEA) from 8.0 to 38 µg/L. CT shows a peritoneal metastases of 32 mm located on the diaphragm invading the liver (A). Cryoablation was performed using three needles (B; transverse CT, C; sagittal CT). Coronal CT images show complete ablation after one month (D), and local control after 5 months (E) and 3 years (F) with a stable CEA varying between 5.6 and 7.0 µg/L

Fig. 2

A 67-year-old female patient presents with a peritoneal metastases of granulosa cell carcinoma in the epigastric region of 13 mm (A). Cryoablation with one needle with hydrodissection for stomach proximity (B). Follow-up CT shows complete ablation after one month (C) and persistent local control after 27 months (D)

Fig. 3

A 76-year-old female patient with a non-visceral metastases of RCC in the abdominal wall of 22 mm (A) after nephrectomy, which was previously treated with SBRT and twice with radiofrequency ablation. Hydrodissection (B) was performed for bowel proximity and one needle was used during cryoablation (C). Follow-up CT shows complete ablation after one month (D), and persistent local control after 8 months (E). Local tumor progression was detected after 14 months (F) which was left untreated and closely monitored with watchful waiting