HEPATIC CRYOSURGERY IN TREATING COLORECTAL METASTASES

Background. The purpose of this study was to determine the effectivene ss of cryosurgery as an adjunct to resection in treating patients with hepatic metastases from colorectal adenocarcinoma. Methods. Forty-sev en patients with documented metastases limited to the liver from color ectal adenocarcinoma were treated with cryosurgery with or without res ection from November 1987 to February 1992 and were followed until Feb ruary 1994. Intraoperative ultrasound was used to map the lesions and place the cryoprobes. Each lesion was frozen to -196 degrees centigrad e for 15 minutes, thawed for 10 minutes, and frozen again for 15 minut es. Follow-up computed tomographic scans were obtained before hospital discharge and 6 months and 1 year after cryosurgery. Carcinoembryonic antigen levels were obtained monthly. Results. Thirty-one males and 1 6 females, with a median age of 63 years, were treated. The median hos pital stay was 10 days, and follow-up ranged from 24 to 57 months, wit h a median follow-up of 26 months. The actual survival at 24 months wa s 62%. Eleven percent of these patients had no evidence of disease at a median follow-up of 30 months. Complications included myoglobinuria, coagulopathy, pleural effusions, and bile duct injuries. Two patients (4%) died because of multisystem organ failure with irreversible coag ulopathies. Conclusions. Cryosurgical ablation increases the number of patients with liver metastases who potentially can become disease fre e. However, the effect on overall survival will require a longer follo w-up period.