Most hepatocellular carcinomas are not amenable to resection and are resistant to radiation and chemotherapy. We undertook a retrospective review to evaluate the effectof cryosurgery using a novel multiple-probe technique in patients with unresectable hepatoma.
Eighteen patients were diagnosed with unresectable hepatocellular carcinoma between 01/11/93 and 06/09/97. Mean age was 66 years (range 33-79). All patients had cirrhosis. Nine lesions were centrally located. Median lesion size was 6.8 cm (range 3-12). Five patients (28%) had been treated unsuccessfully with chemotherapy, and two had undergone prior resection.
Cryosurgical ablation was performed with sequential placement of up to five hollow steel cryoprobes. A single 12-28 min freeze was monitored by intra-operative ultrasound. Sixteen patients were treated with curative intent and two for palliation. Tumor markers and perioperative complications were evaluated. Survival was calculated using lifetable analysis.
There was no intra-operative mortality. Post-operative morbidity was limited to one case of bleeding that required reoperation. Mean maximal post-operative reduction in alfa fetoprotein was 87% in curative cases and 54% in palliative cases. At a mean follow-up of 19 months (range 2-56), local recurrence was 17%. Two patients underwent a second cryoablation and are currently disease free. There were four deaths (one unrelated to the procedure, two in the palliative group, and one in the curative group). Mean survival was 19 months post-cryosurgery and 27 months post-diagnosis. Nine patients are currently disease free.
Since most hepatomas are not amenable to resection, cryoablation with multiple probes is an excellent alternative, particularly in patients with severe cirrhosis and marginal hepatic function.