Cryosurgical ablation of hepatic metastases from colorectal carcinomas

Surgical resection remains the only curative therapy for hepatic metastases from colon and rectal carcinoma. Many patients will be unresectable or have close microscopic margins. Cryoablation may improve local control and survival in those cases. From February 1992 to May 1995, patients with metastatic colon and rectal carcinoma who underwent cryoablation of surgical margins following hepatic resection or cryoablation of hepatic metastases were reviewed with attention to patient and tumor characteristics, clinical course, local control, and survival. Twenty-four patients (10 female, 14 male) with a mean age of 63 years (range, 34-84 years) underwent cryosurgical ablation for hepatic metastases. Twelve were for central lesions and 12 for gross or microscopically positive resection margins. Surgery was performed with curative intent for 21 and for palliation in 3 patients. The mean hospital stay was 8.4 days (range, 5-15 days). Complications included three cases of parenchymal cracking and a single bile leak. Two of 14 patients who developed pleural effusions required treatment. Perioperative mortality was 8.3 per cent (2 of 24): one myocardial infarction and one cerebrovascular accident. Four of 21 treated for cure had hepatic recurrence, and six had only extrahepatic recurrence. Median time to recurrence was 9.5 months. With median follow-up of 19 months, mean actuarial disease-free (DFS) and overall survival (OS) rates are as follows. Those with central lesions (n = 12) had a mean OS rate of 31 months and a mean DFS rate of 23 months. Those with close resection margins (n = 12) had a mean OS rate of 31 months and a median DFS rate of 19.5 months. Total patients (n = 24) had a mean OS rate of 32.7 months and a mean DFS rate of 23.5 months. We conclude that cryoablation of unresectable hepatic metastases or close resection margins is safe and may allow for improved survival in selected patients with metastatic colon and rectal carcinoma.