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René Adam, MD,PhD; Ellen J. Hagopian, MD; Marcelo Linhares, MD; Jinane Krissat, MD; Eric Savier, MD; Daniel Azoulay, MD,PhD; Francis Kunstlinger, MD; Denis Castaing, MD; Henri Bismuth, MD

Arch Surg. 2002;137:1332-1339.

Hypothesis  The complication and success rates in patients treated with either percutaneous cryosurgery (PCS) or percutaneous radiofrequency (PRF) for unresectable hepatic malignancies are similar.

Design  Retrospective study.

Setting  University hospital.

Patients and Methods  Sixty-four patients were treated with either PCS (n = 31) or PRF (n = 33). Patient treatment was based on the random availability of the probes. Tumors were evaluated by a blinded comparison of pretreatment and posttreatment helical computed tomographic scans. All living patients had at least a 6-month follow-up.

Main Outcome Measures  Complication rate, initial treatment success (complete devascularization of the tumor), and local recurrence (tumor revascularization within or at its periphery).

Results  The distribution of tumor types was similar in the 2 groups (P = .76). One patient with cirrhosis died of variceal hemorrhage on day 30 after PCS (mortality, 3.2%), while no mortality was observed after PRF (P = .48). Complications occurred in 9 (29%) of the patients following PCS and in 8 (24%) of the patients following PRF (P = .66). Initial treatment success was comparable in the 2 treatment groups (30 [83%] of 36 tumors following PCS vs 34 [83%] of 41 tumors following PRF). However, local recurrences occurred more frequently after PCS than after PRF (16 [53%] of 30 vs 6 [18%] of 34; P = .003). The higher rate of local recurrence was identified for metastases (10 [71%] of 14 after PCS vs 3 [19%] of 16 after PRF; P = .004), while the difference was not significant for hepatocellular carcinoma (6 [38%] of 16 after PCS vs 3 [17%] of 18 after PRF; P = .25). Multivariate analysis demonstrated that the use of PCS (P = .003) and more than 1 treatment (P = .05) were independent risk factors for local tumor recurrence.

Conclusion  While similar initial treatment success and complication rates are observed following either PCS or PRF, local recurrences occur more frequently following PCS, particularly for metastases.

From the Department of Hepatobiliary Surgery and Liver Transplantation, Centre Hepato-Biliaire, Hôpital Paul Brousse, Université Paris Sud, Villejuif, France.

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