Cryotherapy of the resection edge after liver resection for colorectal cancer metastases.

Abstract

An involved or inadequate (< 1 cm) resection margin is associated with a high rate of local tumour recurrence and reduced survival rates after liver resection for colorectal metastases. This paper assesses whether or not hepatic cryotherapy of the resection edge is suitable to improve local disease control. From April 1990 to May 1997, we performed cryotherapy of the resection edge in 44 patients after liver resection for colo rectal liver metastases with an involved or inadequate resection margin. The reasons for performing edge cryotherapy instead of extension of resection were: proximity of hepatic veins or portal sheath (n = 12); avoidance of extended left or right hemihepatectomy (n = 15); inadequate liver tissue reserve after resection (n = 16); and patient unfit to undergo further major resection (n = 1). Histological examination showed the resection margin to be involved in 24 patients and close (< 1 cm) in 20 patients. Two patients died after surgery. Morbidity consisted of intra-abdominal collections (n = 6), postoperative bleeding (n = 1), wound infection (n = 1) and transient liver failure (n = 1). At a median follow-up of 19 months, 16 patients are alive and disease-free, 26 patients developed recurrence and 15 of them died. Nineteen patients developed recurrence which involved the liver but only five of these were at the resection edge. Median overall and liver disease-free survival was 33 and 23 months, respectively. Cryotherapy of the resection edge after resection of colorectal liver metastases with involved or inadequate resection margins considerably improves local disease control and may allow a greater proportion of patients with liver metastases to undergo potentially curative treatment.