Recurrence and Survival Outcomes after Hepatic Resection with or without Cryotherapy for Liver Metastases from Colorectal Carcinoma

Abstract

Long-term survival results of resection combined with cryotherapy for multiple bilobar CRLM are comparable to that of resection alone in selected patients.

Resection and Ablation for Colorectal Liver Metastases

“…Seifert et al achieved 5-year survival rates of 26% in the hepatic cryotherapy group and 23% in the resection group; accompanied by mortality rates of 2% and 5%, respectively [59]. Similar survival results can be achieved when using cryotherapy as an adjunct to resection to treat non-resectable CLMs, with 5-year overall survival of 32% following resection alone, and 24% following cryotherapy and resection (p = 0.206) [80]. Application of hepatic cryotherapy has undoubtedly extended treatment to otherwise incurable CLMs.…”

“…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...…”

“…The median, 1-, 2-, 3-, 5-, and 10-year disease-free survivals reported were 9 -27 months [59,72,77,78,81,82,84,86,88], 38% -41% [58,78,82,86], 16% -35% [58,78,86], 8% -17% [78,82,86], 12% -13% [59,82], and 11% [82], respectively (Figure 4). Approximately 80% of surgically treated CLMs will develop some form of recurrence; and the pattern of recurrence had been variably described [61,64,70,71,78,80,82,86]. Metastatic pulmonary disease was the most common initial site of extrahepatic recurrence observed.…”

“…Tumour number and size: More number of lesions is predictive of poorer disease-free survival following hepatic cryotherapy [63,71,72,78,80,86,87,89,91]. Nonetheless, the efficacy of this ablative modality is undeniable.…”

“…While number is not a limitation to surgical intervention provided there is sufficient post-operative functional hepatic parenchyma, survival is inversely proportional to size [60,61,63,66,80,86,89]. All except one study have described better or equivalent survival outcome in patients undergoing synchronous hepatic resection and cryotherapy compared to cryotherapy alone [71,72,80].…”