Rationale for the combination of cryoablation with surgical resection of hepatic tumors

Only 5% to 10% of metastatic and primary liver turners are amenable to surg ical resection. Hepatic cryoablation has increased the number of patients w ho are suitable for curative treatment. The aim of this study was to evalua te survival and intrahepatic recurrence in patients treated with cryoablati on and resection. From June 1994 to July 1999, thirty-eight surgically unre sectable patients underwent a total of 42 cryoablative procedures for 65 ma lignant hepatic lesions. Twenty patients underwent cryoablation alone, and 18 patients were treated with a combination of resection and cr)cryoablatio n, with a minimum of 18 months' follow-up. The 38 patients had the followin g malignancies: primary hepatocellular carcinoma (n = 8) and metastases fro m colorectal cancer (n = 21), neuroendocrine tumors (n = 3), ovarian cancer (n = 3), leiomyosarcoma (n = I), testicular cancer (n = 1), and endometria l cancer (n = I). Patients were evaluated preoperatively with spiral CT sca ns and intraoperatively with ultrasound examinations for lesion location an d cryoprobe guidance. Local recurrence was detected by CT. Major complicati ons included bleeding in three patients and acute renal failure, transient liver insufficiency, and postoperative pneumonia in one patient each. Two p atients (5%) died during the early postoperative interval; mean hospital st ay was 7.1 days. Median follow-up was 28 months (range 18 to 51 months). Ov erall survival according to Kaplan-Meier analysis was 82%, 65%, and 54% at 12, 24, and 48 months, respectively. Forty-eight-month survival was not sig nificantly different between those patients undergoing cryoablation alone ( 64%) and those treated with a combination of resection anti cryoablation (4 2%,). Disease-free survival at 45 months was 36% for patients undergoing cr yoablation plus resect ion compared to 25% for those undergoing cryoablatio n alone. Local recurrences were detected at five cryosurgical sites, for a rate of 12 % overall (5 of 42), 11% (2 of 18) for patients in the cryoablat ion plus resection group, and 12% (3 of 24) for those in the cryoablation a lone group. For patients with colorectal metastases, survival was 70% at 30 months compared to 33% for hepatocellular cancer and 66% for other types o f tumors. Patients with tumors larger than 5 cm or numbering more than thre e did not have significantly decreased survival. Cryoablation of hepatic tu mors is a safe and effective treatment For some patients not amenable to re section. The combination of cryoablation and resection results in survival comparable to that achieved with cryoablation alone.