From: Proceedings 10th World Congress of Cryosurgery
A Five-Year Institutional Experience with Hepatic Cryosurgery for Unresectable Colorectal Metastases Refractory to Chemotherapy

November 1998
AJ Bilchik, T Sarantou, SL Stem, K Adnani, PI Haigh, KP Ramming
John Wayne Cancer Institute, Century City Hospital, Santa Monica, California

The majority of patients with metastatic colorectal cancer is not amenable to resection and is resistant to adjuvant therapy. Cryosurgery offers a safe, effective alternative. We report our five-year experience in patients with hepatic colorectal metastasis refractory to chemotherapy (rising CEA - mean 166.7, CT scan progression). Between July 1992 and July 1997, 121 patients underwent cryo - 51 females, 70 males, ages 30-76 (median 60). Patients were evaluated preoperatively with spiral CT scan and intraoperatively with ultrasound. Lesions were frozen with liquid nitrogen, delivered by insulated probes for 15 minutes at 190C. The iceball was monitored with real time ultrasound. Multiple probes were used for lesions larger than 5 cm. One to fifteen lesions were frozen (mean 3.4, median 3, mean size 3.1 cm). Patients with multiple lesions (>5) also underwent hepatic artery pump placement for regional chemotherapy (HAI) (n=37). There was one operative death. Average ICU and hospital stays were 1.5 and 6 days respectively. Median follow up from surgery was 13 months (1-58 months). Mean reduction in CEA levels was 68%, 80% for cryo alone and 56% for cryo with regional chemotherapy.

Survival from Cryo Survival from Date of DX of Liver Mets

Year Cryo + Pump Cryo Alone Cryo + Pump Cryo Alone

1 63% 70% 78% 91%

2 34% 35% 49% 62%

3 18% 14% 30% 41%

4 0% 10% 0% 27%

Overall median survival was 29.1 months (20.6 months with pump, 30.8 months cryo) from diagnosis of liver mets. Regional chemotherapy may improve survival in patients with large or multiple lesions. Cryo is an effective alternative treatment for patients with unresectable hepatic metastases unresponsive to pre-op chemotherapy.

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