IS CRYOSURGICAL ABLATION APPROPRIATE FOR TREATING HEPATOCELLULAR CANCER

Objective: To examine the feasibility and efficacy of cryosurgical abl ation as treatment for patients with cirrhosis with unresectable hepat ocellular carcinoma. Design: Retrospective case series. Setting: A ter tiary public hospital and a cancer center. Patients: Twelve patients w ith cirrhosis with hepatocellular carcinoma (stage II, 2; stage III, 1 ; stage IVA, 7; stage IVB, 2). Interventions: Cryosurgical ablation of all identifiable tumors. Nine patients treated with curative intent w ere included in the survival analysis, and 3 were treated for palliati on. Five patients were treated with preoperative intra-arterial chemoe mbolization. Main Outcome Measures: Perioperative complications and th e effects of tumor stage and chemoembolization were examined. Patient survival and disease-free interval were calculated by life-table analy sis. Results: No perioperative deaths occurred and 1 patient had 2 pos toperative complications: pneumonia and biloma. The mean survival has been 19 months after cryosurgical ablation and 29 months after diagnos is. Three of the 9 patients treated with curative intent died with rec urrence at a mean of 17 months after cryosurgical ablation. Four patie nts are alive with recurrence at a mean of 19 months after cryosurgica l ablation and 38 months after diagnosis. Two patients with stage II d isease have no evidence of recurrence 10 and 32 months after cryosurgi cal ablation. Conclusions: Cryosurgical ablation is feasible and safe for treatment of hepatocellular carcinoma in patients with cirrhosis. The technique is primarily palliative but may provide a possibility of cure in patients with lower-stage disease.