Cryotherapy for liver metastases

Cryotherapy is undergoing a renaissance in the treatment of nonresectable l iver tumors. In a prospective case control study we assessed the morbidity, mortality, and efficacy of hepatic cryotherapy for liver metastases. Betwe en January 1996 and September 1999 a total of 54 cryosurgical procedures we re performed on 49 patients (median age 66 years, 21 women) with liver meta stases. Patient, tumor, and operative details were recorded prospectively. Liver metastases originated from colorectal cancer (n=37), gastric cancer ( n=3), renal cell carcinoma (n=2), and other primaries (n=7). Median follow- up was 13 months (1-32). The median number of liver metastases was 3 (range 1-10) with a median diameter of 3.9 cm (range 1.5-11). Twenty-one patients (43%) had cryoablation only, and 28 (57%) had liver resection in combinati on with cryoablation. One patient (2%) died within 30 postoperative days. A nother 13 patients (27%) developed reversible complications. In 19 of 25 pa tients (76%) with preoperatively elevated serum CEA and colorectal metastas es it returned to the normal range postoperatively. Twenty-eight patients ( 57%) developed tumor recurrence, eight of which with involvement of the cry osite. Overall median survival patients was 23 months, and survival in pati ents with colorectal metastases was 29 months. Hepatic cryotherapy is assoc iated with tolerable morbidity and mortality. Efficacy is demonstrated by t umor marker results. Survival data are promising; however, longterm results must be provided to allow comparison with other treatment modalities.