Hepatic cryotherapy for liver tumors

Abstract

A high-efficiency hepatic cryosurgical unit has been developed and evaluated. It is capable of simultaneously driving three implantable insulated cryoneedle probes. The system has been used to treat 18 patients with secondary and 4 patients with primary liver cancer: open (n = 12), total laparoscopic (n = 6), laparoscopic assisted (n = 4). In three patient laparoscopic cryotherapy was repeated inside 6 months. Intraoperative bleeding was encountered in three patients undergoing high-volume hepatic freezing but the bleeding was easily controlled. A fall in the core body temperature was encountered in 10 out of 22 patients and averaged 0.4 degree C. There was one postoperative death from liver failure in an 80-year-old patient in whom a large hepatoma was frozen. The most consistent postoperative biochemical change was hyperbilirubinaemia (n = 3). A right-sided pleural effusion developed in two patients after freezing of lesions on the superior surface of the right lobe. A survival benefit was encountered in three patients, one with central cholangiocarcinoma and the other two with large solitary secondary deposits (melanoma, colon cancer). Seven patients with multiple metastases and two patients with large hepatomas developed recurrence at the frozen site or elsewhere in the liver inside 12 months of follow-up and no clinical benefit could be demonstrated by cryotherapy in this group. In nine patients, the follow-up has been too short (< 18 months) to permit any conclusion on outcome. The current limitations of hepatic cryotherapy are largely due to incomplete tumor destruction.(ABSTRACT TRUNCATED AT 250 WORDS)

Radiofrequency Ablation of Malignant Liver Tumors

“…Liver suturing or packing is required to control hemorrhage in most of these cases. Thrombocytopenia and consumptive coagulopathy are not uncommon after hepatic cryoablation and can be the cause of delayed hemorrhage in the treated lesion or at distant sites [29,35,37]. Thrombocytopenia or coagulopathy did not develop in any of our RFA patients.…”

“…In contrast, the mean blood loss reported during cryoablation operations is up to 750 ml, and as many as one-third of patients require blood transfusions [29,33,34]. Intraoperative hemorrhage may occur from the 3-15-mm diameter cryoprobe track or liver surface cracking during thawing of the iceball [29,[35][36][37]. Liver suturing or packing is required to control hemorrhage in most of these cases.…”

Advances in Laparoscopic Surgery

“…The early results seem promising [70]. However the follow-up is too short to conclude that this type of treatment may have more than a palliative effect.…”

Interstitial laser thermotherapy in the treatment of colorectal liver metastases

“…The latter have been shown to be unpredictable in achieving homogeneous and complete necrosis in colorectal metastases [130]. ILT is delivered by a percutaneous technique unlike cryotherapy that requires access by laparotomy or laparoscopy [131,132] for probe placement. It is not limited by the proximity of major vessels and biliary structures.…”