ULTRASOUND-GUIDED LAPAROSCOPIC CRYOABLATION OF HEPATIC-TUMORS - PRELIMINARY-REPORT

The purpose of this ongoing prospective study is to evaluate the feasi bility, safety, and efficacy of a total laparoscopic approach for ultr asound-guided cryoablation of primary and secondary hepatic tumors. Of 56 patients who underwent ultrasound-guided cryoablation, a total lap aroscopic approach was employed in 18 (5 men, 13 women; mean age 48.6 years, range 35-77 Sears). Fifteen patients were included for secondar y hepatic tumors and three for primary hepatic tumors. Selection crite ria were the presence of three or fewer nodules, less than 40% liver v olume replaced by tumor, and absence of extrahepatic disease. Altogeth er 28 lesions were confirmed by intraoperative laparoscopic ultrasonog raphy and were treated; 25 by ultrasound-guided laparoscopic cryoablat ion and 3 by laparoscopic wedge resection. After cryoablation, surface parenchymal splits with bleeding from the frozen tissue were observed in six patients and required conversion to open surgery in two patien ts whose lesions were located in segment 8. No major complication and no mortality were observed. One or more minor complications occurred i n nine patients; they included pleural effusion (n = 8, 44.4%), subdia phragmatic fluid collection (n = 3, 16.6%), worsening hepatic insuffic iency in a cirrhotic patient (n = 1, 5.5%), and wound infection in a p atient converted to open surgery (n = 1, 5.5%). The mean hospital stay was 6.4 days (range 3-14 days).At a mean follow-up of 10.8 months (ra nge 5-16 months) all patients are alive and 14 are disease-free, as de monstrated by normalization of tumor markers and negative magnetic res onance Imaging. In carefully selected patients total laparoscopic ultr asound-guided cryoablation is feasible and safe. A longer period of fo llow-up is required to evaluate the efficacy of the procedure and its impact on survival.