CRYOSURGICAL TREATMENT OF HEPATIC AND RENAL TUMORSFebruary 1997
A. Paganini, F.Lugnani, A. Tamburini,F. Feliciotti, M. Guerrieri, E. Lezoche
Istituto Scienze Chirurgiche. University of Ancona, Ancona. Italy
Aim of the study was to evaluate safety and efficacy of open cryosurgery for the treatment of renal tumors and of laparoscopic or open cryosurgery for the treatment of primary and secondary hepatic tumors, with no evidence of extrahepatic disease except for the primary tumor in case of synchronous lesions.
From February to November 1996, 33 patients (pts) (14 males, 19 females, mean age 56.1 years, age range 37-77 years) were included, 19 of whom with unresectable hepatic lesions. Diagnosis was: clear cell renal adenocarcinoma (1), hepatocellular carcinoma (3), hepatic adenoma (1), secondary hepatic tumors from colo-rectal adenocarcinoma (22) and gastric adenocarcinoma (2), from ileal carcinoid (3), from breast cancer (1). Of 28 pts with secondary hepatic tumors ì, 19 had metachronus and 9 had synchronus lesions. Laparoscopic cryoablation of hepatic tumors was indicated for 0<, 3 lesions. Ethanol injection (E.I.) of the portion of lesions closest to larger vessels was employed to overcome the heat-sink effect. Peripheral hepatic lesions were resected.
Three pts with hepatic tumors were excluded at laparotomy due to carcinosis. 33 patients undewent cryoblation, in 7 cases by laparoscopy. The primary intestinal tumor was treated concurrently in 8 of 9 pts with synchronous hepatic lesions. Mean number of hepatic lesions was 4.1 (range 1-21), of size up to 10cm. Distribution by segment was:I-3, II-16, III-14, IV-15, V-19, VI-19, VII-29, VIII-29. 91 lesionswere cryoablated, combined with resection or E.I. in the same patients to treat 53 more lesions. Total operative time was 346 minutes (range 250- 525). Incomplete hepatic cryoablation was present at the end of the procedure in 4 cases due to extensive hepatic tumor involvment. Preoperative morbidity was: pleural effusion (13), tubular necrosis (3), subhepatic blood collection (6), hepatic insufficiency (3), bleeding (5). Death from hepato-renal syndrome occurred in 2 patients (6%). Mean hospital stay for laparoscopic cases was 9.1 plus or minus 3.6 days and for open cases was 14.5 plus or minus 6.8 days (p<0.5). At follow-up of up to 8 months (MRI and umor markers) 23 patients are hepatic disease-free (1 of whom developed pulmonary methastasis), and 6 developped new hepatic lesions. Death from hepatic failure occurred in 1 patient, 1 month after after discharge.
Laparoscopic or open cryoablation is safe and effective for both unresectable and resectable hepatic tumors as well as for renal tumors. When feasable, the laparoscopic approach allows shorter hospital stay and should be considered the treatment of choice. Longer follow-up is required to evaluate the impact of cryosurgery on survival.