Cryo-Forum

HIGH-TECH SURGERY IN THE TREATMENT OF PRIMARY AND SECONDARY HEPATIC TUMORS. A COMPARISON OF METHODOLOGIES.

September 1997
Lecturer: Prof. Emanuele Lezoche, professor of surgypathology at Ancona University.
Statistics say that every year, in Italy, 10,000 people die of primay and secondary hepatic tumors.
These figures are surely optimistic. Infact, if we think that on the 15,000 cases of diagnosed colon-rectum tumor alone, about 25% show imediate hepatic metastases (simultaneous metastases) and 40% will show them later on (metachronous metastases), we will see how, in our Country, there are over 3,000 cases a year of simultaneous metastases to which should be added the cases of metachronous metastases.
But we should also bear in mind that all other gastrointestinal tumors, together with kidney, breast and oophron tumors, develop hepatic metastases. It is therefore clear that we have a large number of patients with primary and secondary hepatic traumas, who need adequate therapy.
The above figures clearly indicate the economic and social importance of hepatic traumas in our country.
Till today, the only therapy which could guarantee a long-term disease-free-survival, has been surgical oblation. But this can be performed only on 5-10% of all cases of hepatic metastases and on 20-30% of primary hepatic tumor cases, and, even then, mortality (about 5%) and postoperative complications (about 30%) should not be disregarded.
Other therapies have been associated with surgery or have substituted surgery when the latter proved unsuitable. Such therapies are: chemiotherapy, chemio-embolization and alcoholisation of the tumor.
Next to these now commonly-used therapies, new ones are emerging and gaining importance, such as radiofrequency treatments, lasertherapy and cryosurgery, which is being more and more applied both in the U.S. and in Europe.
In Italy this therapy is applied only at the Ancona Surgical Centre, directed by prof. Emanuele Lezoche and looked up to by some of the most important Italian hospitals such as the "Silvestrini" Hospital in Perugia, the "Annunziata" Hospital in Cosenza, the "Pugliese" Hospital in Catanzaro, and the Sassari hospital. The Transplant Centre of the "Sapienza" University in Rome, also takes part in these studies, for the cases in which liver tansplants are possible.
In order to examine the results of these diffrent techniques, and in particular cryosurgery, prof. Emanuele Lezoche organised an inter- disciplinary monothematic Congress, titled "High-tech cryosurgery in the treatment of primary and secondary hepatic tumors. A comparison of methodologies", which has taken place in ancona on June 4th 1996, with the presence of all major Italian and European experts.


CRYOSURGERY
The technological progresses that have been made over these last few years through space-technology, have made it possible to build complex apparata that, thanks to special probes, can take tissue temperature to -200C. This, of course, has nothing to do with the traditional cryotherapy used, for example, in the treatment of haemorroids with a temperature of about -30C.
Cryosurgery, used for the ultrasound guided cryoablation, has recently been proposed for the treatment of hepatic, kidney, prostatic and gynecological tumors. The idea is to freeze (-200C) and devitalize the neoplastic tissue in situ. The advantage being that the disease-free tissu, located next to the trauma, suffers much less than from surgical abscission.
The freezing process (ice-ball) is constantly monitored through an intraoperative ecography until the ice-ball embraces the whole neoplastic area and a disease-free margin of 1 cm. This therapy requires a particularly well-trained medical team both for the cryosurgical apparata and for the monitoring.
the apparata used in the Surgypathology Department of the Ancona "Umberto I" Hospital, is one of the very few now operating in the world, and the third in Europe.
It is worth noticing that this therapy can also be used with minimum-inasive surgical techniques. Prof. A. Cuschieri of Dundee University has spoken of the minimum-invasive cryosurgical treatment of hepatic metastases, in detail. Whereas prof. Lezoche has shown a film describing the treatment of a hepatic trauma with the laparoscopic approach. Even though this latter tecnique can be employed in a small number of cases, it offers all the advantages of the minimum-invasive technique and ensures a very favourable post-operative course, scarcely traumatic for the patient who can soon return to his working life.


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