Cryosurgical ablation of hepatic colorectal metastases

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Hepatic resection is the treatment of choice for primary and secondary hepatic tumors but only 15-25% of patients with hepatic colorectal metastases are eligible for a curative hepatic resection. Cryosurgical ablation (CSA) is employed when curative resection of metastases cannot be obtained. Sixty-four patients (35 males, 29 females, mean age 58.8 years, range 30-79 years) with hepatic colorectal metastases underwent CSA, under laparoscopic control (15 cases) or with open surgery (49 cases), with subsequent close follow-up. Intraoperative bleeding occurred in 32 out of 49 patients in the open group and only in 2 patients in the laparoscopic group. Minor morbidity that resolved with conservative treatment was 54.8% in the open group and 53.3% in the laparoscopic group. Major morbidity occurred in 11 cases (26.2%) in the open group and in 1 case (6.7%) in the laparoscopic group. Mortality occurred in two patients, both in the open group, from renal insufficiency in one case and from liver failure in the other case. Mean hospital stay was 16.7 days in the open group (range 8-72 days) and 10.6 days in the laparoscopic group (range 3-18 days). No patient was lost to follow-up. At a mean follow-up of 87.1 months (range 52.2-125.2 months), selected patients undergoing laparoscopic CSA had an overall survival rate of 66.7% (10 patients), with 30% of patients (3) who are disease-free. Median survival was 94.2 months. Recurrence was observed in seven patients. None of the intrahepatic recurrences was at the cryoablation site. In the open group, median survival was 22.9 months with a survival rate of 30.9% (13 patients) at a mean follow-up of 39.3 months (range 1.9-124.5 months); 9 patients (19.1%) are disease-free. In selected patients, laparoscopic CSA is associated with survival rates which are similar to those after hepatic resection. In patients with a larger tumor burden, CSA offers a curative treatment to patients with otherwise a dismal prognosis and it improves survival as compared to patients receiving chemotherapy alone. However, the procedure is associated with substantial morbidity, particularly bleeding, and therefore careful patient selection is recommended.