
Cryo ablation of hepatic metastases is safe, provides excellent palliation of symptoms, and in selected patients can be performed with curative intent. Indications for cryosurgical ablation included bilobar and centrally located disease [multiple unresectable liver metastases], poor medical risk, insufficient hepatic reserve, and involved margin after wedge resection. 

Cryosurgical ablation of hepatic tumors relies on nonspecific tissue necrosis due to freezing, as well as microvascular thrombosis. The tumor is flash frozen by the cryosurgery trochar to a very low temperature.  It is then allowed to defrost, and in that process the spicules of ice crystals formed physically tear apart the membrane of the cell.  The freezing-defrost cycle is repeated, so that all cells are lysed [broken apart].

Patients with selected primary and metastatic hepatic malignancies who are NOT candidates for surgical resection are afforded potentially curative benefit using this technique. Although hepatic cryosurgery offers some unequivocal and other potential advantages over surgical resection for colorectal metastases to the liver, the published data do not support its use in patients with resectable disease.   Surgical resection remains the treatment of choice for hepatic metastases of LMS.
&&url
&&url
&&url

Whether used alone or in association with surgical resection, cryotherapy of liver metastases is a specialized technique that should be done in a specialized liver facility, as should surgical resections of the liver. Intraoperative ultrasound should be used in all patients to help locate the tumor and guide the cryosurgical trochar to the lesions. 

Complications of the procedure include: the liver tissue cracking with subsequent bleeding--possibly requiring transfusion, bile leaks, injury to surrounding structures/organs [i.e. inferior vena cava], pleural effusions [water on the lung], postoperative biliary stenosis [bile duct narrowing]. 

See  &&url
See  &&url      
For the latest information, Search PubMed for &&url
Below are some selected abstracts of medical journal articles that deal with cryotherapy of liver metastases. 


<b>Cryosurgery in the Treatment of Liver Metastases
Selected Annotated Medical Journal References</b>
[For the full abstract, use the links provided, or search on Pubmed.  Ed.]


Anticancer Res 2000 Sep-Oct;20(5C):3785-90 
<b>Cryosurgery as a means to improve surgical treatment of patients with multiple unresectable liver metastases. </b>
Rivoire M, De Cian F, Meeus P, Gignoux B, Frering B, Kaemmerlen P. 
Department of Surgery, Centre Leon Berard, 28, Rue Laennec, 69373 Lyon, France. rivoire@lyon.fnclcc.fr 

... The aim of the study was to evaluate the results of cryosurgery in patients with multiple (five or more), heavily pretreated, unresectable liver metastases. ... 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. ... Cryosurgery may be effective in the treatment of patients with multiple unresectable liver metastases and should be investigated in multimodality treatment programmes. 
&&url PMID: 11268455 


Clin Exp Dermatol 1995 Jan;20(1):22-6 
<b>Response of leiomyosarcoma to cryosurgery: clinicopathological and ultrastructural study. </b>
Montes LF, Ocampo J, Garcia NJ, Vaccaro F, Arra A, Abulafia J, Wilborn WH, Lembrande RG. 
Structural Research Center, Mobile, AL, USA. 

Two elderly patients with primary leiomyosarcoma (LMS) of the scalp were treated cryosurgically. Complete involution of both tumours with full epithelialization of the affected sites was achieved. Pretreatment biopsies and sequential biopsies obtained after treatment allowed observation of microscopical changes taking place during tumour involution. Gradual shrinkage of both LMS, closely monitored under the operating microscope, started immediately after the initial freezing. Light and electron microscopic observation of the shrinking LMS revealed a rapid disappearance of the tumoral architecture. ... Two years after treatment, both patients showed no signs of recurrence. These results suggest cryosurgery--performed in an extended protracted fashion--can be a valuable therapeutic choice in the management of LMS, particularly when surgical excision is not feasible. 
&&url PMID: 7671391 


Am J Surg 1999 Dec;178(6):592-9 
<b>Intraoperative radiofrequency ablation or cryoablation for hepatic malignancies. </b>
Pearson AS, Izzo F, Fleming RY, Ellis LM, Delrio P, Roh MS, Granchi J, Curley SA. 
Department of Surgical Oncology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA. 

... The majority of patients with primary or metastatic malignancies confined to the liver are not candidates for resection because of tumor size, location, multifocality, or inadequate functional hepatic reserve. Cryoablation has become a common treatment in select groups of these patients with unresectable liver tumors. However, hepatic cryoablation is associated with significant morbidity. Radiofrequency ablation (RFA) is a technique that destroys liver tumors in situ by localized application of heat to produce coagulative necrosis. In this study, we compared the complication and early local recurrence rates in patients with unresectable malignant liver tumors treated with either cryoablation or RFA. ... Cryoablation was performed on 88 tumors in 54 patients, and RFA was used to treat 138 tumors in 92 patients. Treatment-related complications, including 1 postoperative death, occurred in 22 of the 54 patients treated with cryoablation (40.7% complication rate). In contrast, there were no treatment-related deaths and only 3 complications after RFA (3.3% complication rate, P<0.001). With a median follow-up of 15 months in both patient groups, tumor has recurred in 3 of 138 lesions treated with RFA (2.2%), versus 12 of 88 tumors treated with cryoablation (13.6%, P<0.01). 
...RFA is a safe, well-tolerated treatment for patients with unresectable hepatic malignancies. This study indicates that (1) complications occur much less frequently following RFA of liver tumors compared with cryoablation of liver tumors, and (2) early local tumor recurrence is infrequent following RFA. 
&&url PMID: 10670879 

  
J Surg Oncol 1998 Aug;68(4):242-5 
<b>Cryosurgical ablation of unresectable hepatic metastases.</b> [None are Sarcomas. ed.] 
Dale PS, Souza JW, Brewer DA. 
Division of Surgical Oncology, Mercer University School of Medicine, Macon, Georgia, USA. 

... Recent advancements in the technology of cryosurgery along with the development and refinement of intraoperative ultrasound have led to a feasible alternative for some patients with unresectable hepatic malignancy. This paper reports our first year's experience with cryosurgical ablation of unresectable hepatic malignancies... CONCLUSIONS: Cryosurgical ablation is a safe method of treating unresectable hepatic malignancies and it may extend survival in carefully selected patients. 
&&url PMID: 9721710  


Am J Surg 1997 Dec;174(6):614-7; discussion 617-8 
<b>Cryosurgical ablation of hepatic tumors.</b> [None are Sarcomas...ed.] 
Crews KA, Kuhn JA, McCarty TM, Fisher TL, Goldstein RM, Preskitt JT. 
Department of Surgery, Baylor University Medical Center, Dallas 75246, USA. 

BACKGROUND: Cryosurgical ablation of hepatic tumors relies on nonspecific tissue necrosis due to freezing as well as microvascular thrombosis. Patients with selected primary and metastatic hepatic malignancies who are not candidates for surgical resection are afforded potentially curative benefit using this technique. ... Intraoperative ultrasound (IOUS) was used in all patients to help locate the tumor and guide the cryosurgical trocar to the lesions.  ...  Indications for cryosurgical ablation included bilobar and centrally located disease, poor medical risk, insufficient hepatic reserve, and involved margin after wedge resection. 
Major complications included hepatic parenchyma cracking requiring transfusion in 5 patients, 1 postoperative biliary stenosis, and 1 inferior vena cava injury. There were 3 postoperative deaths from non-hepatic-related events. ... The pattern of failure was identified at the site of cryosurgical ablation in 2 of 88 lesions. ...Cryosurgical ablation of selected hepatic malignancies is a safe and viable treatment for patients not amenable to surgical resection. 
&&url PMID: 9409584 


Am Surg 1997 Jan;63(1):63-8 
<b>Cryosurgical ablation of hepatic metastases from colorectal carcinomas. </b>
Yeh KA, Fortunato L, Hoffman JP, Eisenberg BL. Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA. 
Surgical resection remains the only curative therapy for hepatic metastases from colon and rectal carcinoma. Many patients will be unresectable or have close microscopic margins. Cryoablation may improve local control and survival in those cases. ... We conclude that cryoablation of unresectable hepatic metastases or close resection margins is safe and may allow for improved survival in selected patients with metastatic colon and rectal carcinoma. 
&&url PMID: 8985074 