HEPATIC CRYOTHERAPY FOR LIVER-TUMORS - DEVELOPMENT AND CLINICAL-EVALUATION OF A HIGH-EFFICIENCY INSULATED MULTINEEDLE PROBE SYSTEM FOR OPENAND LAPAROSCOPIC USE

A high-efficiency hepatic cryosurgical unit has been developed and eva luated. It is capable of simultaneously driving three implantable insu lated cryoneedle probes. The system has been used to treat 18 patients with secondary and 4 patients with primary liver cancer: open(n = 12) , total laparoscopic (n = 6), laparoscopic assisted (n = 4). In three patient laparoscopic cryotherapy was repeated inside 6 months. Intraop erative bleeding was encountered in three patients undergoing high-vol ume hepatic freezing but the bleeding was easily controlled. A fall in the core body temperature was encountered in 10 out of 22 patients an d averaged 0.4 degrees C. There was one postoperative death from liver failure in an 80-year-old patient in whom a large hepatoma was frozen . The most consistent postoperative biochemical change was hyperbiliru binaemia (n = 3). A right-sided pleural effusion developed in two pati ents after freezing of lesions on the superior surface of the right lo be. A survival benefit was encountered in three patients, one with cen tral cholangiocarcinoma and the other two with large solitary secondar y deposits (melanoma, colon cancer). Seven patients with multiple meta stases and two patients with large hepatomas developed recurrence at t he frozen site or elsewhere in the liver inside 12 months of follow-up and no clinical benefit could be demonstrated by cryotherapy in this group. In nine patients, the follow-up has been too short (<18 months) to permit any conclusion on outcome. The current limitations of hepat ic cryotherapy are largely due to incomplete tumor destruction. The us e of insulated laparoscopic cryoprobes which can be positioned under v isual control through the parietes in the optimal site for maximal tum or ablation should enhance the therapeutic efficiency of cryotherapy f or both primary and secondary hepatic tumors.