Cryosurgery as a means to improve surgical treatment of patients with multiple unresectable liver metastases.
BACKGROUND
The aim of the study was to evaluate the results of cryosurgery in patients with multiple (five or more), heavily pretreated, unresectable liver metastases.


METHODS
Nineteen patients with multiple unresectable liver metastases were entered into a prospective nonrandomized trial. The liver tumours were treated during surgery under ultrasound guidance. All the patients were followed-up to assess complications, treatment response and sites of recurrence.


RESULTS
140 metastases were identified in 19 patients (mean, 7; range, 5-25) and 13 patients had a synchronous liver resection. Cryosurgery was used to treat 90 metastases (mean diameter, 30 mm; range, 10-135). There were no treatment-related deaths and the overall rate of complications was 21%. During a mean follow-up of 28 months (range, 5-60), tumours recurred at the site of cryosurgery in two patients (10%), in the remaining liver in nine patients (47%) and elsewhere in five patients (26%). Three patients had no evidence of disease 48, 50 and 60 months after liver cryosurgery, respectively.


CONCLUSIONS
Cryosurgery may be effective in the treatment of patients with multiple unresectable liver metastases and should be investigated in multimodality treatment programmes.
Rivoire
M
M
Department of Surgery, Centre Léon Bérard, 28, Rue Laënnec, 69373 Lyon, France. rivoire@lyon.fnclcc.fr
De Cian
F
F
Meeus
P
P
Gignoux
B
B
Fréring
B
B
Kaemmerlen
P
P
D000230:Adenocarcinoma / Q000473:pathology / Q000556:secondary / Q000601:surgery; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology; D015179:Colorectal Neoplasms / Q000473:pathology; D003131:Combined Modality Therapy; D003452:Cryosurgery; D018572:Disease-Free Survival; D005134:Eye Neoplasms / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D005770:Gastrointestinal Neoplasms / Q000473:pathology; D006801:Humans; D007890:Leiomyosarcoma / Q000556:secondary / Q000601:surgery; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008545:Melanoma / Q000556:secondary / Q000601:surgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D010190:Pancreatic Neoplasms / Q000473:pathology; D011446:Prospective Studies; D015996:Survival Rate; D013997:Time Factors