Feasibility and safety of percutaneous cryoablation for treatment of peritoneal metastases.

OBJECTIVES: To evaluate the feasibility, safety, and local-control outcomes of percutaneous cryoablation for treatment of peritoneal metastases. METHODS: Retrospective review of an institutional ablation database identified 28 patients (57% female, mean age 67.7 ± 13.8 years) who underwent 31 cryoablation procedures for treatment of 32 peritoneal metastases between January 2011 and January 2026. Patient characteristics, procedural details, adverse events, and oncologic outcomes were recorded. Adverse events were classified according to Society of Interventional Radiology criteria. Freedom from local progression was estimated at the patient level using an interval-censored Turnbull estimator, with sensitivity analysis estimating cumulative incidence of detected local progression with death considered as a competing event. RESULTS: Technical success was achieved in all 31 procedures. Hydrodisplacement of bowel was performed in 22 procedures (71%). Adverse events occurred after 3 procedures (9.7%), including one major adverse event (3.2%). There was no procedure-related mortality. Patient-level local control failure after the index cryoablation procedure occurred in 10 of 28 patients. Estimated freedom from local progression was 62.7% (95% CI, 37.7%-100%) at 365 days. In competing-risk analysis, the cumulative incidence of detected local progression before death was 28.6% (95% CI, 15.9%-51.3%) at 365 days. New peritoneal metastases outside the ablation zone developed after 21 of 31 sessions (67.7%) at a median of 4.5 months. CONCLUSION: In selected patients, percutaneous cryoablation of peritoneal metastases was technically feasible with infrequent adverse events. New peritoneal disease was common, supporting a role for cryoablation as an adjunctive focal therapy within a multimodality treatment paradigm rather than as a definitive therapy.