Perioperative complications of using freezing nitrogen ethanol composite to treat bone tumors - Clinical experience from a single center

Sep 29, 2026

The study evaluates perioperative complication rates when semisolid freezing nitrogen ethanol composite (FNEC) is used as an adjuvant to assist cryoablation for bone tumors across different bone cavity types. Patient medical charts from December 2013 to January 2018 were reviewed and cavities were grouped by liquid spill potential. Results among 76 patients show a 6.4% overall perioperative complication rate with superficial skin issues manageable by oral antibiotics and no early neuropraxia.

LanguageEnglish

CategoryResearch & Report

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Pages6

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Abstract

Background

Methods

Results

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Introduction

J Chin MedAssoc Original article Perioperative complications of using freezing nitrogen ethanol composite to treat bone tumors: Clinical experience from a single center Yi-Chou Chena,b, Chao-Ming Chenc,d,e, Kuan-Lin Chenc,d,e, Pai-Han Wangc,d,e, Cheng-Fong Chenc,d,e, Po-Kuei Wuc,d,e,* , Wei-Ming Chenc,d,e aDepartment of Orthopedics, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan, ROC; bInstitute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, ROC; cDepartment of Orthopedics and Joint Reconstruction, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; dOrthopedic Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; eTherapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei, Taiwan, ROC Abstract Background: The cryoablation efficacy of semisolid freezing nitrogen ethanol composite (FNEC) has been demonstrated. We aimed to investigate the feasibility of adjuvant FNEC–assisted cryoablation in different bone cavity types by assessing the perioperative complication rates. Methods: The medical charts of patients who received intraoperative adjuvant cryoablation using semisolid FNEC for bone tumors from December 2013 to January 2018 were reviewed. The bone cavities were categorized into three types according to liquid spill potential (type 1, able to hold liquid without limb manipulation; type 2, required extensive limb manipulation to retain liquid; type 3, unable to retain liquid) . The overall complication rate and the complication rates stratified by bone cavity type were determined. Results: Among the 76 patients, 30.3%, 57.9%, and 11.8% had type 1, 2, and 3 bone cavities, respectively. The mean follow-up time for perioperative complications was 43.5 ± 24.1 days. Five patients experienced complications, including two cases of skin damage, two cases of skin infection, and one case of fracture, yielding an overall perioperative complication rate of 6.4% . All cases of skin damage and skin infection were superficial and manageable by oral antibiotics. The patient with a pathologic fracture recovered well after being treated with open reduction and plate fixation. No neuropraxia was noted within the first few days postsurgery in any patient. The complication rates in type 1, 2, and 3 bone cavities were 13%, 4.6%, and 0%, respectively. Conclusion: All bone cavity types had a low incidence of perioperative complications after treatment with adjuvant FNEC–assisted cryoablation. Semisolid FNEC–assisted cryoablation is a feasible alternative to overcome the liquid spill potential in bone cavities resulting from tumor resection and intralesional curettage. Keywords: Bone neoplasms; Cryosurgery; Ethanol; Freezing 1. INTRODUCTION The technique of intralesional curettage combined with adjuvant cryoablation has been used to control local recurrence and to treat aggressive benign bone tumors, low-grade malignant bone tumors, and metastatic bone tumors. Studies have shown that extended curettage alone has a lower complication rate and better functional outcomes than does wide resection for * Address correspondence. Dr. Po-Kuei Wu, Orthopedic Department, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, [ROC. E-mail address: drwuvgh@gmail.com](ROC. E-mail address: drwuvgh@gmail.com) (P.-K. Wu). Conflicts of interest: Dr. Po-Kuei Wu and Dr. Wei-Ming Chen, editorial board members at Journal of the Chinese Medical Association, have no roles in the peer review process of or decision to publish this article. The other authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article. Journal of Chinese Medical Association. (2024) 87: 64-69. Received October 2, 2023; accepted October 21, 2023. doi: 10. 1097/JCMA.0000000000001018 Copyright © 2023, the Chinese Medical Association. This is an open access

FAQs

What is the purpose of using semisolid FNEC in cryoablation for bone tumors?

To assess the feasibility of FNEC-assisted cryoablation by evaluating perioperative complication rates in different bone cavity types.

How were bone cavity types classified in the study?

By liquid spill potential: type 1 holds liquid without limb manipulation, type 2 requires extensive limb manipulation to retain liquid, and type 3 cannot retain liquid.

What complications were observed, and how were they managed?

Five patients experienced complications: two skin damage cases, two skin infection cases, and one fracture. Skin complications were superficial and managed with oral antibiotics, and the pathologic fracture recovered after open reduction and plate fixation.

Sep 29, 2026

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