Cryosurgery for unresectable primary hepatocellular carcinoma: A case report and review of literature

Primary liver cancers are a significant cause of both morbidity and mortali ty. Although surgical resection remains the treatment of choice for these t umors, only 10 to 20 per cent of the primary liver tumors are found to be r esectable. Presently, the options for these patients include liver transpla ntation, cryosurgery, or nonsurgical therapy, such as transarterial chemoem bolization. Techniques such as alcohol injection, interstitial radiotherapy , laser hypothermia, and radiofrequency electrodissection have all been att empted with limited success. We present a case of a 68-year-old woman with a 10-year history of liver cirrhosis secondary to chronic active hepatitis C. A lateral segmentectomy was recommended but could not be done due to sev ere underlying cirrhosis. Cryosurgery aided by intraoperative ultrasonograp hy was performed successfully. The patient developed recurrent disease at 5 8 months and died with disease at 62 months. Advances in instrumentation an d intraoperative ultrasonography are making cryosurgery a viable surgical t herapeutic alternative in the management of patients with unresectable hepa tocellular carcinoma. The procedure can be performed safely with low morbid ity.