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Multiple bilobar liver metastases: cryotherapy for residual lesions after liver resection
P M Hewitt1, S J Dwerryhouse, J Zhao
1Department of Surgery, University of New South Wales, St. George Hospital, Kogarah, Sydney, Australia.
Background And Objectives:
Most patients with colorectal liver metastases are not eligible for resection because they have multiple lesions or because of anatomical constraints. We report the use of cryotherapy to destroy residual metastases following liver resection in patients with disease too widespread for treatment by resection alone.
Methods:
Twenty patients with bilobar disease confined to the liver (median 3; range 2-8 lesions) were treated in this way. Seventeen patients also received regional chemotherapy postoperatively.
Results:
Morbidity was high, but there were no procedure-related deaths and only one patient's hospital stay exceeded 24 days. Significant destruction of tumor, as evidenced by a decline in CEA levels, occurred within 3 months of surgery in all patients (P < 0.001). Median duration of follow-up was 15 (6-53) months. Survival rates at 1 and 2 years were 88% and 60%, respectively, and median survival was 32 months. Seven patients remain well and seven are alive with recurrent liver and/or other metastases.
Conclusions:
Although this is not a control study, it would appear that some patients with irresectable liver metastases benefit from this multimodality approach.