This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Cryotherapeutic ablation of liver tumours. BJS 2002; 89: 1396-1401.
Published: 2nd December 2002
Authors: A. J. Sheen, G. J. Poston, D. J. Sherlock
Background
This paper reports a 7‐year experience of cryoablation for colorectal and non‐colorectal liver metastases.
Method
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 µg/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).
Conclusion
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. © 2002 British Journal of Surgery Society Ltd
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