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Hepatic Cryoablation, But Not Radiofrequency Ablation, Results in Lung Inflammation

Chapman, William C. MD*; Debelak, Jacob P. MS*; Wright Pinson, C. MD*; Washington, M. Kay MD, PhD; Atkinson, James B. MD; Venkatakrishnan, Annapurna MS; Blackwell, Timothy S. MD; Christman, John W. MD

Scientific Papers

Objective To compare the effects of 35% hepatic cryoablation with a similar degree of radiofrequency ablation (RFA) on lung inflammation, nuclear factor κB (NF-κB) activation, and production of NF-κB dependent cytokines.

Summary Background Data Multisystem injury, including acute lung injury, is a severe complication associated with hepatic cryoablation of 30% to 35% or more of liver parenchyma, but this complication has not been reported with RFA.

Methods Sprague-Dawley rats underwent 35% hepatic cryoablation or RFA and were killed at 1, 2, and 6 hours. Liver and lung tissue were freeze-clamped for measurement of NF-κB activation, which was detected by electrophoretic mobility shift assay. Serum concentrations of tumor necrosis factor α and macrophage inflammatory protein 2 were measured by enzyme-linked immunosorbent assay. Histologic studies of pulmonary tissue and electron microscopy of ablated liver tissue were compared among treatment groups.

Results Histologic lung sections after cryoablation showed multiple foci of perivenular inflammation, with activated lymphocytes, foamy macrophages, and neutrophils. In animals undergoing RFA, inflammatory foci were not present. NF-κB activation was detected at 1 hour in both liver and lung tissue samples of animals undergoing cryoablation but not after RFA, and serum cytokine levels were significantly elevated in cryoablation versus RFA animals. Electron microscopy of cryoablation-treated liver tissue demonstrated disruption of the hepatocyte plasma membrane with extension of intact hepatocyte organelles into the space of Disse; RFA-treated liver tissue demonstrated coagulative destruction of hepatocyte organelles within an intact plasma membrane. To determine the stimulus for systemic inflammation, rats treated with cryoablation had either immediate resection of the ablated segment or delayed resection after a 15-minute thawing interval. Immediate resection of the cryoablated liver tissue prevented NF-κB activation and lung injury; however, pulmonary inflammatory changes were present when as little as a 15-minute thaw interval preceded hepatic resection.

Conclusions Hepatic cryoablation, but not RFA, induces NF-κB activation in the nonablated liver and lung and is associated with acute lung injury. Lung inflammation is associated with the thawing phase of cryoablation and may be related to soluble mediator(s) released from the cryoablated tissue. These findings correlate the clinical observation of an increased incidence of multisystem injury, including adult respiratory distress syndrome (ARDS), after cryoablation but not RFA.

From the *Division of Hepatobiliary Surgery and Liver Transplantation, the †Department of Pathology, and the ‡Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center and the Department of Veterans Affairs, Nashville, Tennessee

Correspondence: William C. Chapman, MD, Dept. of Hepatobiliary Surgery and Liver Transplantation, 801 Oxford House, Nashville, TN 37232-4753.

Presented at the 111th Annual Meeting of the Southern Surgical Association, December 5–8, 1999, The Homestead, Hot Springs, Virginia.

Supported in part by the U.S. Department of Veterans Affairs through Merit Funding.


Accepted for publication December 1999.

© 2000 Lippincott Williams & Wilkins, Inc.