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Vanderbilt experience with cryosurgery for 25 advanced hepatic tumors
F F Haddad1, J K Wright, T K Blair
1Department of Surgery, Vanderbilt University School of Medicine, Nashville, USA.
Tennessee Medicine : Journal of the Tennessee Medical Association
|September 16, 1998
Summary
Cryoablation combined with surgical resection offers a way to manage advanced liver tumors, achieving complete tumor ablation in selected patients. While complications like coagulation abnormalities are common, survival rates at 36 months reached 20%.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Interventional Radiology
Background:
- Hepatobiliary malignancies present significant treatment challenges, often requiring multimodal approaches.
- Cryosurgical techniques are being explored as adjuncts or alternatives to traditional surgical resection.
- Advanced liver tumors frequently necessitate aggressive management strategies to improve patient outcomes.
Purpose of the Study:
- To evaluate the clinical outcomes of cryoablation used in conjunction with surgical resection for advanced hepatic tumors.
- To assess the safety and efficacy of cryoablation in achieving tumor-free margins and complete tumor ablation.
- To determine the survival rates and complication profile associated with this combined therapeutic approach.
Main Methods:
- Cryoablation was applied to 44 of 91 lesions in 25 patients with advanced liver tumors.
- The technique was used to achieve tumor-free margins, manage multiple nodules, or enhance chemotherapy response.
- Cryoablation was performed independently in four patients and combined with hepatic resection in 21 patients.
Main Results:
- Survival rates at 6, 12, 18, 24, and 36 months were 96%, 66%, 49%, 35%, and 20%, respectively.
- Surgical mortality was 4%, with a morbidity rate of 68%.
- Common complications included significant reductions in platelet counts (60% >50% reduction) and elevated PT levels, with specific instances of hemorrhage.
Conclusions:
- Cryoablation can be a valuable complement to surgical resection for selected patients with advanced hepatobiliary tumors, enabling complete tumor ablation.
- Careful application of cryoablation, potentially with vascular isolation techniques, can address lesions near major vessels.
- This approach helps define the risks and benefits of combining cryosurgery with resection for complex liver cancer cases.