Percutaneous Puncture Cryoablation in Patients with Rib Metastatic Lesions

Introduction. The method of mininvasive percutaneous cryoablation is applied in the tumor lesions of bones for the purpose of local control and pain syndrome relief. In the case of chest bone destruction, such procedures are accompanied by a risk of damage to the thoracic and abdominal organs, as well as large vessels. This article discusses the peculiarities of percutaneous puncture cryoablation in patients with rib metastatic lesions.

Aim. To analyze the methodological aspects of percutaneous cryoablation in patients with rib metastatic lesions and to clarify puncture stereotactic accesses.

Materials and methods. The procedure was performed in 11 patients with oligometastatic bone lesions. The size of rib lesions varied from 7 to 55 mm. Surgery was performed in a CT operating room under endotracheal anesthesia. A nitric cryosystem with reusable probes of a diameter varying from 1.5 to 3.0 mm was used. The cryoablation included two cycles of cooling down to the target temperature of –190 °C with 10- and 6-min exposure, respectively.

Results and discussion. As a result, optimum puncture accesses for the installation of cryoprobes in tumoral rib destruction, including tangential and perpendicular ones, were proposed. At the tangential access, the cryoprobe can be placed both directly into the tumor lesion (intraosseous variant) and into soft tissues along the bone at the lesion level (paraosseous variant). The follow-up period after the procedure varied from 3 to 27 months (11.4 ± 5.6 months). In 3 cases, the formation of a pathological fracture at the level of the ablated lesion was recorded. The local control of the tumoral process was achieved in 10 patients, a relapse in the ablation zone was noted in one case 3 months after the procedure.

Conclusion. Due to the use of the described accesses, as well as the implementation of measures aimed at preventing cold cutaneous lesions, the surgery goals were successfully achieved and complications were avoided in all cases.

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