PLACE OF CRYOSURGERY IN THE TREATMENT OF MALIGNANT LIVER-TUMORS

Objective The authors evaluate the results of cryosurgery in malignant liver tumors. Summary Background Data The outcome of primary or secon dary achieved. Encouraging results of cryosurgery have been reported i n unresectable liver tumors, but this treatment needs further evaluati on of its efficacy in homogeneous groups of patients. Methods From 63 patients with malignant liver tumors with various histology treated by cryosurgery in a 2.5-year period, the authors evaluated the results o f 34 patients with nonresectable hepatocellular carcinoma (9 patients) or nonresectable metastases from colorectal cancer (25 patients). Cry osurgery was used either as a single treatment (4 hepatocellular carci nomas, 5 metastases) or in association with liver resection (5 hepatoc ellular carcinomas, 20 metastases). Systemic chemotherapy was used rou tinely before surgery and after surgery.Results There was no intraoper ative mortality. Mortality within 2 months was 3% and was unrelated to the procedure. Postoperative morbidity consisted of one sterile fluid collection and one biliary fistula (8%). Ata mean follow-up of 16 mon ths, (range, 2-27) local recurrence rate was 0% for hepatocellular car cinoma and 44% for metastases. Cumulative survival at 24 months was 63 % and 52%, respectively, with 6 patients (67%) and 5 patients (20%) cu rrently disease free. In the group of patients with metastases, surviv al was related to the size of the treated tumor (p=0.06) and the absen ce of residual disease (p=0.03). Conclusions Cryosurgery is safe and i ncreases the number of patients with unresectable liver malignancies i n whom surgery can aim at eradicating the tumor. Local recurrence is o bserved more frequently for metastases than for hepatocellular carcino ma. The benefit in survival is related to the complete treatment of th e tumoral disease.