Cryosurgery gains increasing significance in the therapy of irresectable hepatic malignancies. Cryotherapy (CS) is usually carried out via laparotorny.
Patients and Method: Of 58 patients with irresectable liver tumors undergoing CS (using ERBE CRYO 6, Tiibingen, FRG) between 08/95 and 01/98, 10 patients were not suitable for open procedure. There were 6 patients with a total of 8 metastases, 4 patients had hepatocellular carcinomas. Since their tumors could be well-demonstrated via ultrasound, we performed ultrasonographically-guided percutaneous puncture with thin needles under general anesthesia and placed 3 min cryoprobes over corresponding guide wires (application-set Onik/Cohen). Thermocouples were introduced for safety reasons. Depending on tumor size, several probes were used. The ultrasonographically-monitored ice front had to exceed the tumor margin by at least I cm.
Results: Percutaneous cryoablation under ultrasound guidance was feasible in all patients without conversion into open operation. There were no intraoperative complications. The mean operation time was 115 minutes (range: 85 to 156 min), 70 minutes less than for corresponding open CS. All patients recovered rapidly. According to MRI findings, primary destruction was achieved for 6 of 8 metastases and 3 of the 4 hepatocellular tumors. After a mean follow up of 11.5 months, one metastasis had recurred 3 months post procedure and one patient showed disseminated metastatic disease 10 months after freezing.
Conclusion: Percutaneous cryotherapy provides a useful therapeutic option for a selected group of patients not amenable to open procedures