title: Is cryosurgical ablation appropriate for treating hepatocellular cancer?
abstract: OBJECTIVE
  To examine the feasibility and efficacy of cryosurgical ablation as treatment for patients with cirrhosis with unresectable hepatocellular carcinoma.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  A tertiary public hospital and a cancer center.
  
  
  METHODS
  Twelve patients with cirrhosis with hepatocellular carcinoma (stage II, 2; stage III, 1; stage IVA, 7; stage IVB, 2).
  
  
  METHODS
  Cryosurgical ablation of all identifiable tumors. Nine patients treated with curative intent were included in the survival analysis, and 3 were treated for palliation. Five patients were treated with preoperative intra-arterial chemoembolization.
  
  
  METHODS
  Perioperative complications and the effects of tumor stage and chemoembolization were examined. Patient survival and disease-free interval were calculated by life-table analysis.
  
  
  RESULTS
  No perioperative deaths occurred and 1 patient had 2 postoperative complications: pneumonia and biloma. The mean survival has been 19 months after cryosurgical ablation and 29 months after diagnosis. Three of the 9 patients treated with curative intent died with recurrence at a mean of 17 months after cryosurgical ablation. Four patients are alive with recurrence at a mean of 19 months after cryosurgical ablation and 38 months after diagnosis. Two patients with stage II disease have no evidence of recurrence 10 and 32 months after cryosurgical ablation.
  
  
  CONCLUSIONS
  Cryosurgical ablation is feasible and safe for treatment of hepatocellular carcinoma in patients with cirrhosis. The technique is primarily palliative but may provide a possibility of cure in patients with lower-stage disease.
authors.affiliation: Department of Surgery, University of Southern California School of Medicine, Los Angeles, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Wren
authors.forename: M M
authors.initials: MM
authors.lastname: Coburn
authors.forename: M
authors.initials: M
authors.lastname: Tan
authors.forename: J R
authors.initials: JR
authors.lastname: Daniels
authors.forename: N
authors.initials: N
authors.lastname: Yassa
authors.forename: C L
authors.initials: CL
authors.lastname: Carpenter
authors.forename: S C
authors.initials: SC
authors.lastname: Stain
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000401:mortality / Q000601:surgery*; D003452:Cryosurgery; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology / Q000601:surgery*; D008113:Liver Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate