Hepatic Cryotherapy and SubsequentHepatic Arterial Chemotherapyfor Colorectal Metastases to the Liver

Abstract

This paper presents an experience of thirty consecutive patients with hepatic colorectal metastases who were treated with hepatic cryotherapy and subsequent hepatic arterial infusion (HAI) chemotherapy using 5FU. Patients with colorectal metastases confined to the liver but not suitable for resection, and with liver involvement of less than 50% were offered the treatment. Prospective documentation of all patients was undertaken with data being recorded on a computerised database. Patients had a median of 6 (2–15) lesions with sizes ranging from 1–12 cm. There was no 30 day mortality. Postoperative complications developed in 8 patients but were followed by full recovery in all instances. Side effects from chemotherapy occured in 23% of cycles. Twenty seven patients have died. Median survival from the time of cryotherapy was 18.2 months (7–34), or 23months (9–44) from diagnosis of liver lesions. Hepatic cryotherapy with subsequent arterial chemotherapy is safe and well tolerated. The results suggest survival of patients with colorectal hepatic metastases can be improved by the use of this modality of treatment.

SELECTIVE INTERNAL RADIATION THERAPY WITH 90Y MICROSPHERES FOR COLORECTAL LIVER METASTASES: SINGLE‐CENTRE EXPERIENCE WITH 100 PATIENTS

“…This feature makes the CRC liver metastases particularly suitable for regional approaches to treatment. The most commonly applied regional treatments are surgical resection and a variety of ablative techniques, such as cryotherapy 2,3 and radiofrequency ablation 4 . However, these techniques are only applicable to a minority of patients based on the size, number and location of tumours within the liver.…”

Resection and Ablation for Colorectal Liver Metastases

“…Relative to RFA, cryotherapy is associated with higher morbidities and longer hospital stays, as the open approach had been required for application of cryotherapy until recent years. These have been consistently demonstrated in the few comparative studies [59,73,94,95]. Also, there was a non-statistically significant trend towards poorer survival post-cryotherapy compared to RFA [94,95].…”

“…The susceptibility of biliary tree to thermal injury may complicate cryo-treatment with biloma or bile fistula [57,58,63,64,66,69,71,72]. Pleural effusion is common, as it is after other liver surgeries, and may very often be treated conservatively [63,[69][70][71]73].…”

“…The curative potential with cryotherapy in CLMs had been further demonstrated by the 10-year survival of 13% [82]. The available literature on treatment of CLMs with hepatic cryotherapy reports median, 1-, 2-, 3-, 4-, 5-, and 10-year overall survivals of 18 -33 months [56,57,[59][60][61]63,64,66,[70][71][72][73]77,78,[80][81][82][83]85], 78% -92% [56,58,61,63,66,[70][71][72]80,82,83,86], 47% -66% [61,63,66,[70][71][72]80,83,86,87], 29% -50% [56,58,60,63,66,72,80,8...…”

An Overview of the Surgical Management of Hepatic Neuroendocrine Metastases

“…This reverse heat-sinking effect can result in viable tumour remaining within treated lesions and may explain the relatively high local recurrence seen with this technique. Complication rates are relatively high and the major concern with cryotherapy is the cryoshock phenomenon, whereby patients develop a systematic inflammatory response to ablation [29][30][31][32]. The physiological mechanism remains unclear, and the true incidence of cryoshock is difficult to establish because of lack of precise definitions [22].…”