CRYOSURGERY OF LIVER TUMORS

Abstract

Background. The incidence of both malignant and benign liver tumors is steadily increasing. Because signs and symptoms of liver cancer do not usually appear until the late stages, its curable rate remains low. To improve the treatment outcomes, preoperative chemoembolization, sclerobliteration of the vessels and cryoexposure are used. In cases with benign liver tumors, vascular embolization, various types of coagulation and ultra-low temperatures are applied to reduce blood loss and to prevent disease recurrence. Objective: to analyze the results of cryosurgery for malignant and benign liver tumors. Material and methods. The original cryosurgical equipment capable of producing a temperature of -196о C was used. It comprises a cryoultrasonic scalpel, cryodestructor and cryoapplicators from porous titanium nickelide adapted for laparoscopic surgery. Cryosurgery was performed on 81 patients with liver cancer, 6 patients with Klatskin tumor, 141 patients with a hemangioma, and 9 patients with hepatic adenoma. Results. Out of 81 patients with liver cancer, 9 underwent extended hemihepatectomy using a cryoultrasonic scalpel, while the remaining patients underwent liver resection using a conventional scalpel with cryodestruction of the liver stump. Decrease in blood loss by 25 % due to freezing of vessels up to 1 mm was noted. Four patients died after resection of the liver (5.1 %). Tumor recurrence was observed in 3.8 % of the patients. The 1-, 3, and 5-yaer survival rates were 74.6 %, 52 %, and 40 %, respectively. In cases with hemangiomas, 20 cryoresections were performed. There were 91 resections using a conventional scalpel with cryodestruction of the stump and 22 laparoscopic cryodestructions of small hemangiomas (3–5 cm). The use of cryoinstruments reduced intraoperative blood loss and caused aseptic necrosis followed by sclerosis of small hemangiomatous nodes. After resection of the liver, 3 people died (2.7 %), 1 relapse occurred. Concerning liver adenoma, 9 hemihepatectomies with cryodestruction of the stump were performed. There were no lethal outcomes and relapses of the disease. Conclusion. Cryosurgery for malignant and benign liver tumors can be performed as: 1) cryoresection; 2) conventional resections with cryodestruction of the stump 3) cryodestruction of small hemangiomas and metastatic nodes, including laparoscopic approach. The use of ultra-low temperatures reduces blood loss and improves surgical ablation outcomes.