Transpleurodiaphragmatic cryosurgical ablation for recurrent unresectable colorectal liver metastases.
OBJECTIVE
Cryosurgical ablation (CSA) allows the focal destruction of unresectable liver metastases after previous liver resection. The abdominal approach may be difficult for recurrent colorectal cancer metastases located in the upper part of the remaining liver, close to the inferior vena cava (IVC), the hepatic veins, and the diaphragm. A transpleurodiaphragmatic access was assessed for safety and efficacy.


METHODS
Between September 1999 and July 2004, 13 patients with recurrent unresectable colorectal liver metastases underwent transpleurodiaphragmatic CSA via limited right thoracotomy. Seventeen lesions were treated; median diameter was 31 mm (range 13-40 mm). One to three cryoprobes were used, depending on the size and location of metastases.


RESULTS
There was no operative death; three patients developed minor complications (23%). Median hospital stay was 10 days (8-14 days). After a median follow-up of 26 months (range 8-69 months), 9 patients were alive, and 5 were disease-free. Six patients had liver recurrences outside the cryolesion. Median disease free survival was 12 months with 60% 3-year survival after CSA and 58% 5-year survival after first liver surgery.


CONCLUSIONS
Transpleurodiaphragmatic CSA is safe and effective in selected patients with unresectable recurrent liver metastases from colorectal cancer.
Department of Surgery, Centre Léon Bérard, Rue Laënnec, Lyon Cedex, France.
Mattia
M
Stella
François
F
Mithieux
Pierre
P
Meeus
Pierre
P
Kaemmerlen
Cyril
C
Lafon
Michel
M
Rivoire
D000368:Aged; D017115:Catheter Ablation / Q000379:methods*; D015179:Colorectal Neoplasms / Q000473:pathology*; D003452:Cryosurgery; D003964:Diaphragm; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007902:Length of Stay; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D018579:Patient Selection; D010994:Pleura; D013908:Thoracotomy