Percutaneous Cryoablation

Published with the inputs from Dr Jithu Subash Babu, Associate Consultant Interventional Radiology,  Baby Memorial Hospitals- Kozhikode

Percutaneous cryoablation is a minimally invasive, image-guided treatment used to freeze and destroy cancer cells in the liver. The procedure uses specially designed cryoprobes, or thin needles, to deliver extreme cold to the tumour under imaging guidance.

Cryoablation allows precise placement of the cryoprobes and real-time monitoring of the treatment area through the formation of a visible ice ball. It can be considered for selected patients with primary or metastatic liver tumours, including patients who may not be suitable candidates for surgical treatment.

What is percutaneous cryoablation for liver cancer?

Percutaneous cryoablation is a minimally invasive, image-guided treatment in which extreme cold is delivered through specially designed cryoprobes to freeze and destroy cancer cells in the liver.

How is cryoablation performed?

Cryoablation is performed using thin cryoprobes that are precisely positioned within the tumour under imaging guidance. Ultrasound, CT, and fluoroscopy may be used to guide probe placement and monitor the treatment.

When high-pressure argon gas is circulated through the cryoprobe, the temperature drops to approximately -160°C and an ice ball forms at the tip of the probe. Helium gas is then circulated through the probe to thaw the ice ball. This freezing and thawing process causes tumour cell damage and cell death.

How does the ice ball help during cryoablation?

One of the important features of cryoablation is the formation of a clearly visible ice ball around the cryoprobe. This allows the treating physician to monitor the ablation zone in real time and assess the area being treated.

What happens to cancer cells during cryoablation?

During freezing, ice crystals form inside and outside the cells. This increases osmotic pressure, causes cell dehydration, and damages the cell membrane. The freezing and thawing process results in direct and indirect damage to tumour cells, leading to tumour cell death.

What imaging methods are used during cryoablation?

The procedure is performed under image guidance using modalities such as ultrasound, CT, and fluoroscopy. These help with precise placement of the cryoprobes and monitoring of the treatment.

Who may be considered for liver cryoablation?

Cryoablation may be considered for selected patients with liver tumours, particularly when surgical treatment is not suitable. It can be used for selected primary liver tumours as well as metastatic liver tumours.

The doctor has described its use in selected metastatic liver tumours, including metastases from colorectal cancer, breast cancer, pancreatic neuroendocrine tumours, renal cell carcinoma, melanoma, and other malignancies.

Can cryoablation be used for hepatocellular carcinoma?

Yes. Percutaneous cryoablation can be considered as an image-guided local tumour ablation treatment for selected patients with hepatocellular carcinoma.

Can cryoablation be used for metastatic liver tumours?

According to the doctor, cryoablation is increasingly being used for selected metastatic liver tumours, including metastases from colorectal cancer, breast cancer, pancreatic neuroendocrine tumours, renal cell carcinoma, melanoma, and other malignancies.

Can cryoablation be performed without surgery?

Yes. Percutaneous cryoablation is performed through cryoprobes placed through the skin under image guidance, providing a minimally invasive treatment option.

Cryoablation can also be performed during surgery when appropriate.

What are the advantages of cryoablation compared with conventional thermal ablation?

According to the doctor, cryoablation offers several advantages compared with conventional thermal ablation techniques such as microwave ablation (MWA), including:

• Precise real-time visualization of the ice ball during treatment

• Preservation of adjacent large blood vessels with minimal heat-sink effect

• Reduced procedural pain and improved patient comfort

• Potential activation of anti-tumour immune responses

• High precision for tumours located near critical structures

Does cryoablation affect the surrounding healthy liver tissue?

According to the doctor, cryoablation allows tumour cell destruction while producing minimal injury to surrounding healthy liver tissue and preserving adjacent major blood vessels.

Can cryoablation stimulate an immune response?

According to the doctor, cryoablation can stimulate a cryo-immunological response, which may enhance anti-tumour immune activity.

Can cryoablation be combined with other cancer treatments?

Yes. According to the doctor, cryoablation can be combined with other cancer therapies such as:

• Transarterial chemoembolization (TACE)

• Radiation therapy

• Immunotherapy

• Systemic targeted therapies

Such combinations can provide a comprehensive treatment strategy for selected patients.

Is cryoablation an alternative to surgery for liver cancer?

Surgical resection remains the gold standard treatment for hepatocellular carcinoma. However, according to the doctor, only around 25–30% of patients are suitable candidates for surgery at the time of diagnosis.

Patients with underlying cirrhosis, multifocal disease, or medical comorbidities may not be suitable for surgery. For selected patients in these situations, image-guided ablative therapies such as cryoablation may be considered.

How long does the patient stay in the hospital after cryoablation?

The procedure described by the doctor was followed by discharge on the next day. The patient was advised to return for follow-up after four weeks with imaging and blood tests.

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If you have been diagnosed with a liver tumour or would like to know whether percutaneous cryoablation may be suitable for your condition, consult the Interventional Radiology specialists at Baby Memorial Hospital (BMH) for a detailed evaluation and treatment plan.

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