CRYOSURGICAL ABLATION OF HEPATIC-TUMORS

BACKGROUND: Cryosurgical ablation of hepatic tumors relies on nonspeci fic tissue necrosis due to freezing as well as microvascular thrombosi s, Patients with selected primary and metastatic hepatic malignancies who are not candidates for surgical resection are afforded potentially curative benefit using this technique. METHODS: Forty patients underw ent cryosurgery for hepatic malignancy related to colorectal metastasi s (n = 27), hepatocellular carcinoma (n = 8), metastatic breast (n = 2 ), metastatic neuroendocrine (n = 2), and metastatic ovarian carcinoma (n = 1). Intraoperative ultrasound (IOUS) was used in all patients to help locate the tumor and guide the cryosurgical trocar to the lesion s. RESULTS: Indications for cryosurgical ablation included bilobar and centrally located disease, poor medical risk, insufficient hepatic re serve, and involved margin after wedge resection, Major complications included hepatic parenchyma cracking requiring transfusion in 5 patien ts, 1 postoperative biliary stenosis, and 1 inferior vena cava injury. There were 3 postoperative deaths from non-hepatic-related events. Ba sed on Kaplan-Meier analysis the estimated overall survival for patien ts with hepatocellular carcinoma (60% at 18 months) was compared with patients with colorectal metastases (30% at 18 months). Nine patients (23%) are currently free of disease with an average follow-up of 17.7 months. The pattern of failure was identified at the site of cryosurgi cal ablation in 2 of 88 lesions. CONCLUSIONS: Cryosurgical ablation of selected hepatic malignancies is a safe and viable treatment for pati ents not amenable to surgical resection. (C) 1997 by Excerpta Medica, Inc.