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Cryosurgery for malignant tumours of the liver
J G McKinnon1, W J Temple, D A Wiseman
1Department of Surgery, University of Calgary, Alta.
Objective:
To evaluate the safety and efficacy of ultrasound-guided cryosurgery to treat malignant tumours of the liver.
Design:
A prospective nonrandomized trial. The follow-up was complete and ranged from 8 to 35 months.
Setting:
A university-affiliated hospital.
Patients:
Ten patients with secondary malignant tumours of the liver; 1 with primary hepatoma.
Interventions:
Computed portography for preoperative staging; laparotomy and ultrasonographic examination of the liver; cryosurgical ablation of liver tumours with or without a concomitant resection. Thirteen procedures were performed on 11 patients.
Main Outcome Measures:
Preoperative morbidity, disease-free and overall survival.
Results:
Of 24 lesions frozen, the procedure on 4 lesions was considered a technical failure because of persistent disease. There were no perioperative deaths. One patient had a liver abscess that resolved with percutaneous drainage. One patient had a biliary fistula that resolved spontaneously, and one had a transient rise in the serum creatinine level. Of 11 patients treated, 7 had a recurrence in the liver (persistent disease in 2 and new liver metastases in 5); 2 of these patients died. One patient died of distant disease with no local recurrence. At the time of writing, one patient was alive with extrahepatic disease and no local recurrence and two were free of disease.
Conclusions:
Cryosurgery of the liver is a relatively safe procedure that allows treatment of otherwise unresectable malignant disease. Proof of long-term benefit requires further experience and follow-up.