Aim of the study was evaluate safety and efficacy of laparoscopic or open cryosurgery for the treatment of primary/secondary hepatic tumors with no evidence of extrahepatic disease except for the primary tumor (synchronous lesions).
From February 1996 to April 1998, 61 patients (28 males, 33 females, mean age 49.4 years, age range 30-77 years) were included, 35 of whom with unresectable hepatic lesions. Diagnosis was: hepatocellular carcinoma (8), hepatic adenoma (1), secondary hepatic tumors from colorectal (41), gastric (4), breast (4) adenocarcinoma, uterine lymphosarcoma (1) and from ileal carcinoid (2). Of 52 patients with secondary tumors, 42 had metachronous and 10 synchronous lesions. Laparoscopic cryoablation was indicated for =< 3 lesions. Ethanol injection (E.I.) was employed for lesions close to larger vessels. Peripheral lesions were resected.
Sixty-one patients underwent cryoablation. In 20 cases by laparoscopy (3 converted to open surgery). The primary tumor was treated at the same operation in 7 patients with synchronous lesions. Mean number of hepatic lesions was 3.3 (range 1-2 1), of size up to I I cm. Distribution by segment was: 1-2,II-21, III- 17, IV- 19, V-30, VI-32, VII-43, VIII-40. A total of 134 lesions were cryoablated, combined with resection or E.I. in the same patients to treat 68 more lesions. Mean operative time for the entire surgical procedure was 258.3 minutes (range 40-540), whereas mean cryoablation time was 80.2 minutes(range 18-300). Five patients with recurrent tumors have been treated by repeat cryoablation (3) and hepatic resection (2). Complications were: pleural effusion (4), thrombocytopenia (4), abscess (1), biliary fistula (1). Four patients (6.5%) died for hepatorenal syndrome (1), renal failure (1), and massive hepatic post-operative bleeding (2). Mean hospital stay was 13.7 days (range 3-33). A mean follow up of 14.5 months range 1-23 (MRI and tumor markers) survival rate is 90%, 25 patients (43.8%) are disease free and 26 patients (45.6%) have new lesions.
Laparoscopic or open cryo is safe and effective in the short-term period for both unresectable and resectable disease. Continued follow up is required to evaluate its impact on survival.