LAPAROSCOPIC CRYOABLATION OF HEPATIC METASTASES

Objective: To evaluate the feasibility of laparoscopic cryoablation fo r the management of hepatic metastases. Design: Retrospective review. Setting: Tertiary referral center. Patients: Nine patients were evalua ted by laparoscopy for planned laparoscopic cryoablation of hepatic me tastases at The Cleveland Clinic Foundation, Cleveland, Ohio, from Apr il 1996 to May 1997. Results: Laparoscopic exploration revealed diffus e extrahepatic disease not identified by preoperative studies in 2 pat ients. The remaining 7 patients underwent 9 cryotherapy sessions. Duri ng 4 of the cryotherapy sessions, ultrasonography demonstrated unrecog nized additional treatable hepatic lesions. An average of 3 lesions (r ange, 2-5) were treated. Operative time averaged 3.5 hours with a mean intraoperative blood loss of 235 mt. One patient had significant intr aoperative hemorrhage requiring conversion to open hepatic resection f or bleeding control. Eight of the 9 patients tolerated normal diets an d ambulated independently on the first postoperative day. Following cr yotherapy, 4 of the patients developed fever without an infectious sou rce. One patient developed a postoperative bile leak requiring percuta neous biliary stenting. Postoperative hospital stay averaged 4.5 days (median, 4 days; range, 2-14 days). At a mean follow-up of 9 months, 4 of the 7 patients treated are alive without evidence of disease; 2 ar e alive with disease, and 1 patient with a pancreatic primary tumor ha s died of disease. Conclusions: Laparoscopy with laparoscopic ultrason ography is a useful tool in evaluating patients with hepatic metastase s. Laparoscopic cryoablation is feasible and may result in lower posto perative morbidity in patients receiving aggressive treatment for inop erable hepatic metastases.