Hepatic cryosurgery in treating colorectal metastases

Weaver, M. Lance; Atkinson, D; Zemel, Reuben

doi:10.1002/1097-0142(19950715)76:2<210::aid-cncr2820760208>3.0.co;2-s

Cited by 166 publications

(67 citation statements)

References 18 publications

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“…Several studies have reported the results of hepatic cryosurgery for treatment of hepatic colorectal metastases [13][14][15][16] . Sur vival after cryosurgery is probably inferior to that achieved by liver resection, but it should be noted that most of the patients undergoing cryosurgery have non-resectable tumors or later stages of the disease.…”

Section: Discussionsupporting

confidence: 92%

“…The result is consistent with that reported by Weaver et al [15,16] who showed that patients with CEA > 100 ng/dL prior to cryosurgery had only 10 mo median survival, while the median survival of patients with CEA lower than that level was 17-19 mo. The poor outcome of patients with higher CEA may be related to the biological behavior of CEA-secreting tumors.…”

Section: Factors Influencing Survival Of Patientmentioning

confidence: 99%

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Percutaneous cryosurgery for the treatment of hepatic colorectal metastases

Niu²,

He³

et al. 2008

WJG

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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 526 procedures 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 115 patients (41.1%), stable disease (SD) 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. Main 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.

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Section: Discussionsupporting

confidence: 92%

Section: Factors Influencing Survival Of Patientmentioning

confidence: 99%

Percutaneous cryosurgery for the treatment of hepatic colorectal metastases

Niu²,

He³

et al. 2008

WJG

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“…It was as effective as surgical resection for treating metastases to the liver from colorectal carcinomas. 8,9 Because it is a focal treatment, it has the advantage over surgical resection of destroying only the necessary amount of liver tissue, while sparing the uninvolved liver tissue. This is of particular importance for patients with more than four liver metastases because most of them cannot undergo curative liver resection.…”

mentioning

confidence: 99%

Combination of neoadjuvant chemotherapy with cryotherapy and surgical resection for the treatment of unresectable liver metastases from colorectal carcinoma

Rivoire

Cian

Méeus

et al. 2002

Cancer

122

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BACKGROUNDThis retrospective study was conducted to assess the safety, efficacy, and long‐term results of neoadjuvant chemotherapy and cryotherapy as additional means for eradicating liver metastases from colorectal carcinoma when curative treatment was not possible by resection alone.METHODSBetween January 1996 and December 1997, 131 patients with unresectable liver metastases were referred to our department and received chemotherapy. After 3–6 months of chemotherapy, curative surgery of liver metastases was considered possible in 57 patients, either by resection alone in 33 patients (25%) or cryotherapy associated with resection in 24 patients (18%). Characteristics and survival of patients in the cryotherapy plus resection group were compared with those of the 33 patients in the resection group.RESULTSAll patients in the resection group had partial response to neoadjuvant chemotherapy. In the cryotherapy plus resection group, neoadjuvant chemotherapy resulted in 13 partial responses, 9 stable diseases, and 2 disease progressions. The rate of postoperative complications in the entire series was 14%. No major difference was seen between the two groups. After a median follow‐up of 48 months, the median survival time was 39 months. The survival rates at 1, 3, and 4 years were similar in both groups: 94, 58, and 37% in the resection group and 92, 50, and 36% in the cryotherapy plus resection group, respectively.CONCLUSIONSThe combination of neoadjuvant chemotherapy, cryotherapy, and liver resection constitutes a promising treatment strategy for patients with extremely advanced metastatic liver involvement. Patients having more than four liver metastases from a colorectal carcinoma or patients with a poor liver reserve due to previous resection should be screened carefully to determine whether they could be candidates for this procedure. Cancer 2002;95:2283–92. © 2002 American Cancer Society.DOI 10.1002/cncr.10973

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“…The curative potential with cryotherapy in CLMs had been further demonstrated by the 10-year survival of 13% [82]. The available literature on treatment of CLMs with hepatic cryotherapy reports median, 1-, 2-, 3-, 4-, 5-, and 10-year overall survivals of 18 -33 months [56,57,[59][60][61]63,64,66,[70][71][72][73]77,78,[80][81][82][83]85], 78% -92% [56,58,61,63,66,[70][71][72]80,82,83,86], 47% -66% [61,63,66,[70][71][72]80,83,86,87], 29% -50% [56,58,60,63,66,72,80,8...…”

Section: Survivalmentioning

confidence: 99%

“…In some centres, edge cryotherapy had been employed to suboptimal resection margins obtaining median and 5-year survivals of 39 months and 36% [69,82,88,89], respectively; resembling that of clear-margin resections [82,84,[88][89][90]. The median, 1-, 2-, 3-, 5-, and 10-year disease-free survivals reported were 9 -27 months [59,72,77,78,81,82,84,86,88], 38% -41% [58,78,82,86], 16% -35% [58,78,86], 8% -17% [78,82,86], 12% -13% [59,82], and 11% [82], respectively (Figure 4). Approximately 80% of surgically treated CLMs will develop some form of recurrence; and the pattern of recurrence had been variably described [61,64,70,71,78,80,82,86].…”

Section: Recurrencementioning

confidence: 99%

Resection and Ablation for Colorectal Liver Metastases

Ng¹

2013

J Gastrointest Dig Syst

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The surgical approach combining resection and ablation allows for a greater number of patients with colorectal liver metastases who would otherwise be considered to have unresectable disease to be given an opportunity to undergo a curative attempt surgery. Ablation results in local destruction of tumour and is often employed in lesions that are in locations which are not easily resectable. This may involve the use of radiofrequency ablation that causes thermal destruction or cryotherapy that freezes tumours. This review examined the literature reporting resection and ablation of colorectal liver metastases.

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Hepatic cryosurgery in treating colorectal metastases

Cited by 166 publications

References 18 publications

Percutaneous cryosurgery for the treatment of hepatic colorectal metastases

Percutaneous cryosurgery for the treatment of hepatic colorectal metastases

Combination of neoadjuvant chemotherapy with cryotherapy and surgical resection for the treatment of unresectable liver metastases from colorectal carcinoma

Resection and Ablation for Colorectal Liver Metastases

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