Percutaneous Cryoablation of Central Liver Tumors with Thermal Protection of the Bile Duct

To assess the technical feasibility and outcome of cryoablation with simultaneous bile duct protection in patients with centrally located liver tumors (CLLT).

Three patients (all male, 40-79 years) with CLLT located in close proximity to the right (n = 2) or left (n = 1) hepatic duct were included in this retrospective study. Prior to cryoablation, a nasobiliary tube was placed endoscopically in the respective bile duct. In two cases, additional temporary bile duct stent placement was performed. CT-guided cryoablation was realized with simultaneous bile duct perfusion using warm saline. Technical success, effectivity and complications were assessed.

Three CLLT (hepatocellular carcinoma (HCC) n = 2; metastasis n = 1; tumor size 9-15 mm) were treated. Cryoablation was technically successful in all cases and treatment effectivity (A0 ablation) was 100%. Nasobiliary tubes were removed immediately after the ablation procedure, bile duct stents were removed -six to eight weeks after ablation. At the latest available follow-up for each patient (909, 343 and 32 days), no bile duct-related complications were observed. No local tumor recurrence was observed in the two patients who survived longer than three months.

According to our initial experience, percutaneous cryoablation of CLLT with simultaneous bile duct protection is technically feasible without an increased risk of biliary complications and local tumor recurrence.