Cryotherapeutic ablation of liver tumours.
BACKGROUND
This paper reports a 7-year experience of cryoablation for colorectal and non-colorectal liver metastases.


METHODS
A retrospective review was undertaken of patients treated in two adjacent UK centres in the north-west of England.


RESULTS
Over a 7-year period (1993-2000), 57 patients underwent cryotherapy for malignant hepatic tumours (41 colorectal, 16 non-colorectal). In the patients with colorectal metastases, preoperative carcinoembryonic antigen (CEA) levels fell significantly, from a mean of 444.1 to 6.22 micro g/l (P = 0.002). One patient died, two developed cryoshock and six had cardiorespiratory complications. All patients with colorectal metastases subsequently received 5-fluorouracil-based chemotherapy. The remaining 16 patients with non-colorectal tumours (seven neuroendocrine metastases, five hepatocellular carcinomas, three sarcomas, one cholangiocarcinoma) all received cryotherapy alone, with no major complications. The median survival for patients with non-colorectal metastases was 37 months, compared with 22 months for those with colorectal metastases (P = 0.005).


CONCLUSIONS
Hepatic cryotherapy is effective and safe, as demonstrated by the significant reduction in postoperative CEA concentration and the low risk of complications. However, this initial short-term success was not reflected in 5-year survival rates. Cryotherapy for non-colorectal metastases had a greater long-term survival benefit and is a useful means of controlling symptoms.
Sheen
A J
AJ
Department of Surgery, North Manchester Healthcare NHS Trust, Manchester, UK.
Poston
G J
GJ
Sherlock
D J
DJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002272:Carcinoembryonic Antigen / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000601:surgery; D018278:Carcinoma, Neuroendocrine / Q000097:blood / Q000601:surgery; D015179:Colorectal Neoplasms; D003452:Cryosurgery / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis
D002272:Carcinoembryonic Antigen; D006454:Hemoglobins