[Laparoscopic cryoablation of liver tumors]

Hepatic resection remains the gold standard form of treatment for patients with liver metastases. However, only a small percentage of patients are suitable for resection. Local ablation techniques such as cryotherapy have been used with some success in patients with hepatic tumors. We reviewed our experience with cryotherapy via the laparoscopic approach.

Eighteen patients suffering from unresectable liver tumor were treated at our department. Ten patients suffered from colorectal liver metastases, eight patients suffered from hepatocellular carcinoma. Laparoscopic treatment was performed under general anesthesia commencing with laparoscopy and laparoscopic ultrasound (LAPUS) for accurate disease staging. Patients having extrahepatic liver spread were excluded. Patients with unresectable liver tumor with no evidence of extrahepatic disease were then treated with laparoscopic cryoablation. The laparoscopic cryoablation system consisted of two integrated parts: The cryoablation system (Cryo-hit, Galil Medical, Israel; employing Argon/Helium gases using 5 mm needles) combined with Laparoscopic ultrasound system using a 10 mm US probe (Sharplan U-sight system, Israel). Cryoablation treatment (two cycles of 10 minutes each) starts with the insertion of the cryo-needle under US guidance. Two or more needles are inserted according to tumor configuration. Treatment is continuously monitored by LAPUS.

Morbidity consisted mostly of fever (4/18, 22%) due to atelectasis. Two patients bled and were treated conservatively. One patient died following the development of myocardial infarction 3 days after treatment.

After 13-40 months, mean period of 16 months. Eight patients are alive (17, 18, and 29 months, hepatocellular carcinoma; 13-32 months, metastatic disease). It is important to note that 2 patients have had repeat LC and one patient had 3 LC treatments for recurrent metastatic disease.

LC of irresectable liver tumors is feasible, well tolerated and carries relatively low morbidity with no procedure-related mortality. Repeat treatment is possible. Long term survival may be achieved.