CRYOSURGERY IN THE TREATMENT OF METASTATIC COLORECTAL CARCINOMA OF THE LIVER
EDİP AKPINAR, RENE ADAM, MARC JOHANN, FRANCİS KUNSTLINGER, HENRİ BISMUTH
Hepato-Biliyer Cerrahi Merkezi, Paul Brousse Hastanesi ve Güney Paris Üniversitesi Tıp Fakültesi, Villejuif, FRANSA
The single curative option for liver metastases from colorectal cancer is liver resection. However, only 10-12% ot such patients are resectable. Twenty five patients with unresectable colorectal metastases treated by cryosurgery either as a single treatment (5 pts) or associated to liver resection (20 pts) were evaluated. The existence of resectable extrahepatic metastases (overall: 28%) was not an exclusion criterion. Systemic chemotherapy was used routinely pre and post operatively. Operative mortality (within 2 months) was 4% (1 patient) unrelated to cryosurgery. No complications were observed. Local recurrence was 44%. Cumulative survival at 12 months was 77% and at 24 months was 52%. Five patients are stili disease free. Survival was related to the size of the treated tumor (p=0.06) and the absence of residual disease after the cryosurgery either hepatic or extrahepatic (p=0.03).
Cryosurgery is a safe method and it can increase the number of patients who can come to surgery for their unresectable tumors, by helping the destruction of either ill located or bilobar tumors. However, technical improvements require to decrease local recurrences.
Keywords: CRYOSURGERY, LIVER METASTASIS, COLORECTAL CANCER