Limitations

With the exception of CRYODESMO-01 [24, 25], the current literature consists of retrospective single-center series and pooled analysis of heterogenous studies. No randomized trial has compared percutaneous ablation with systemic therapy, surgery, or surveillance, and referral and selection bias likely report improved efficacy. Follow-up durations are often inadequate for a disease characterized by late recurrence.

Technical limitations also warrant emphasis. Durable control depends on complete tumor coverage, which becomes harder as size increases; largest diameter was the only predictor of failure in CRYODESMO-01, and recurrences cluster more commonly at the periphery. Large or anatomically complex lesions may require multiple probes or staged treatment sessions, and tumors near bowel, skin, or neurovascular structures remain challenging despite thermoprotective techniques. Although major complication rates stay below 5%, procedure related morbidity is not negligible, and some patients may need repeat ablation or transition to alternative therapy.