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Comparison of Systemic Responses of Radiofrequency Ablation, Cryotherapy, and Surgical Resection in a Porcine Liver Model

From the Departments of Surgery (KKN, CML, RTP, JYT, YHW, DWH, STF) and Pathology (TWS) and the Centre for the Study of Liver Disease, The University of Hong Kong, Pokfulam, Hong Kong, China.

Correspondence: Address correspondence and reprint requests to: Kelvin K. Ng, MBBS (HK), FRCSEd (Gen), Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China; Fax: 852-28-17-5475; E-mail: kcng66{at}yahoo com.

Background: The degree of systemic response after hepatic radiofrequency ablation (RFA) has not been well investigated.

Methods: An in vivo study was conducted on 23 domestic swine. Different hepatic procedures (RFA, cryotherapy, hepatic pedicle ligation, and hepatectomy) were performed on the medial lobe of the liver (30% of the liver volume). Systemic responses in terms of systemic inflammatory marker changes and end-organ functions were determined.

Results: During the early postoperative period, the systemic inflammatory marker concentrations (tumor necrosis factor- and interleukin-1ß) in the RFA group were significantly lower than in the cryotherapy group but significantly higher than in the control group. The corresponding concentrations in the hepatectomy group remained similar to those in the control group. The pattern of changes of serum inflammatory marker concentrations in the pedicle ligation group followed the pattern in the RFA group. The serum intracellular content concentrations (lactate dehydrogenase and urate) of the cryotherapy group peaked at 6 hours after operation, which was significantly later than in the other groups. Liver function, renal function, and coagulation profiles remained normal in the RFA group. However, the renal function deteriorated in the cryotherapy group on day 1. Both platelet count and activated clotting time showed significant derangement in the cryotherapy group compared with the control group. There was more severe interstitial pneumonitic change of the porcine lung after cryotherapy than after RFA.

Conclusions: The systemic responses of RFA were significantly less severe than those of cryotherapy in this porcine model. However, the increase in serum inflammatory markers and pneumonitis after RFA was substantial when compared with hepatectomy.

Key Words: Systemic • Responses • Radiofrequency • Ablation • Cryotherapy

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