title: Recurrence and survival outcomes after hepatic resection with or without cryotherapy for liver metastases from colorectal carcinoma.
abstract: BACKGROUND
  Some reports support resection combined with cryotherapy for patients with multiple bilobar colorectal liver metastases (CRLM) that would otherwise be ineligible for curative treatments. This series demonstrates long-term results of 415 patients with CRLM who underwent resection with or without cryotherapy.
  
  
  METHODS
  Between April 1990 and January 2006, 291 patients were treated with resection only and 124 patients with combined resection and cryotherapy. Recurrence and survival outcomes were compared. Kaplan-Meier and Cox-regression analyses were used to identify significant prognostic indicators for survival.
  
  
  RESULTS
  Median length of follow-up was 25 months (range 1-124 months). The 30-day perioperative mortality rate was 3.1%. Overall median survival was 32 months (range 1-124 months), with 1-, 3- and 5-year survival values of 85%, 45% and 29%, respectively. The overall recurrence rates were 66% and 78% for resection and resection/cryotherapy groups, respectively. For the resection group, the median survival was 34 months, with 1-, 3- and 5- year survival values of 88%, 47% and 32%, respectively. The median survival for the resection/cryotherapy group was 29 months, with 1-, 3- and 5-year survival values of 84%, 43% and 24%, respectively (P = 0.206). Five factors were independently associated with an improved survival: absence of extrahepatic disease at diagnosis, well- or moderately-differentiated colorectal cancer, largest lesion size being 4 cm or less, a postoperative CEA of 5 ng/ml or less and absence of liver recurrence.
  
  
  CONCLUSIONS
  Long-term survival results of resection combined with cryotherapy for multiple bilobar CRLM are comparable to that of resection alone in selected patients.
authors.affiliation: Department of Surgery, University of New South Wales, St George Hospital, Sydney, NSW 2217, Australia.
authors.forename: Rui
authors.initials: R
authors.lastname: Niu
authors.forename: Tristan D
authors.initials: TD
authors.lastname: Yan
authors.forename: Jacqui C
authors.initials: JC
authors.lastname: Zhu
authors.forename: Deborah
authors.initials: D
authors.lastname: Black
authors.forename: Francis
authors.initials: F
authors.lastname: Chu
authors.forename: David L
authors.initials: DL
authors.lastname: Morris
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology*; D003131:Combined Modality Therapy; D017679:Cryotherapy; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D018579:Patient Selection; D011379:Prognosis; D016019:Survival Analysis