title: Place of cryosurgery in the treatment of malignant liver tumors.
abstract: OBJECTIVE
  The authors evaluate the results of cryosurgery in malignant liver tumors.
  
  
  BACKGROUND
  The outcome of primary or secondary liver tumors is poor when resection can not be achieved. Encouraging results of cryosurgery have been reported in unresectable liver tumors, but this treatment needs further evaluation of its efficacy in homogeneous groups of patients.
  
  
  METHODS
  From 63 patients with malignant liver tumors with various histology treated by cryosurgery in a 2.5-year period, the authors evaluated the results of 34 patients with nonresectable hepatocellular carcinoma (9 patients) or nonresectable metastases from colorectal cancer (25 patients). Cryosurgery was used either as a single treatment (4 hepatocellular carcinomas, 5 metastases) or in association with liver resection (5 hepatocellular carcinomas, 20 metastases). Systemic chemotherapy was used routinely before surgery and after surgery.
  
  
  RESULTS
  There was no intraoperative mortality. Mortality within 2 months was 3% and was unrelated to the procedure. Postoperative morbidity consisted of one sterile fluid collection and one biliary fistula (8%). At a mean follow-up of 16 months, (range, 2-27) local recurrence rate was 0% for hepatocellular carcinoma and 44% for metastases. Cumulative survival at 24 months was 63% and 52%, respectively, with 6 patients (67%) and 5 patients (20%) currently disease free. In the group of patients with metastases, survival was related to the size of the treated tumor (p = 0.06) and the absence of residual disease (p = 0.03).
  
  
  CONCLUSIONS
  Cryosurgery is safe and increases the number of patients with unresectable liver malignancies in whom surgery can aim at eradicating the tumor. Local recurrence is observed more frequently for metastases than for hepatocellular carcinoma. The benefit in survival is related to the complete treatment of the tumoral disease.
authors.affiliation: Liver Transplant Unit, Hôpital Paul Brousse, Université Paris Sud, Villejuif, France.
authors.forename: R
authors.initials: R
authors.lastname: Adam
authors.forename: E
authors.initials: E
authors.lastname: Akpinar
authors.forename: M
authors.initials: M
authors.lastname: Johann
authors.forename: F
authors.initials: F
authors.lastname: Kunstlinger
authors.forename: P
authors.initials: P
authors.lastname: Majno
authors.forename: H
authors.initials: H
authors.lastname: Bismuth
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000556:secondary / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000473:pathology; D003452:Cryosurgery; D006801:Humans; D008113:Liver Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D015996:Survival Rate