Percutaneous cryosurgery for the treatment of hepatic colorectal metastases

AIM:To determine the safety and efficacy of efficacy of percutaneous cryosurgery for treatment of patients with hepatic colorectal metastases.METHODS:Three hundred and twenty-six patients with non-resectable hepatic colorectal metastases underwent percutaneous cryosurgery under the guidance of ultrasound or CT.Follow-up was 1 mo after cryosurgery and then every 4 mo thereafter by assessment of tumor markers,liver ultrasonography,and abdominal CT.For lesions suspicious of recurrence,a liver biopsy was performed and subsequent repeat cryosurgery was given if histology was positive for cancer.RESULTS:All patients underwent a total of 526procedures of cryosurgery.There were 151 patients who underwent repeat procedures of cryosurgery for recurrent tumors in the liver and extrahepatic places.At 3 mo after cryosurgery,carcinoembryonic antigen (CEA) levels in 197 (77.5%) patients who had elevated markers before cryosurgery decreased to normal range.Among 280 patients who received CT following-up,cryotreated lesions showed complete response (CR)in 41 patients (14.6%),partial response (PR) in 115patients (41.1%),stable disease ($D) in 68 patients (24.3%) and progressive disease (PD) in 56 patients (20%).The recurrence rate was 47.2% during a median follow-up of 32 mo (range,7-61).Sixty one percent of the recurrences were seen in liver only and 13.9%in liver and extrahepatic areas.The recurrence rate at cryotreated site was only 6.4% for all cases.During a median follow-up of 36 mo (7-62 mo),the median survival of all patient was 29 mo (range 3-62 mo).Overall survival was 78%,62%,41%,34% and 23% at 1,2,3,4 and 5 years,respectively,after the treatment.Patients with tumor size less than 3 cm,tumor in right lobe of liver,lower CEA levels (< 100 ng/dL) and postcryosurgery TACE had higher survival rate.There was no significant difference in terms of survival based on the number of tumors,pre-cryosurgery chemotherapy and the timing of the development of metastases (synchronous vs metachronous).Patients who underwent 2-3 procedures of cryosurgery had increased survival compared to patients who received cryosurgery once only.There was no intra-cryosurgery mortality,lain adverse effects,such as hepatic bleeding,cryoshock,biliary fistula,liver failure,renal insufficiency and liver abscess were only observed in 0.3%-1.5% of patients.CONCLUSION:Percutaneous cryosurgery was a safe modality for hepatic colorectal metastases.Rather than an alternative to resection,this technique should be regarded as a complement to hepatectomy and as an additional means of achieving tumor eradication when total excision is not possible.