Cryosurgery of Hepatic Malignancy: Is Cryosurgery Appropriate Treatment for hepatic malignancies?

Shin, Dong Hoon

Abstract

PURPOSE: Hepatic resection has proven to be an effective treatment for primary and secondary malignant hepatic tumors, but the majority of patients cannot be treated with resection. Candidates for cryosurgery are patients who are considered unresectable, but who have no evidence of disease outside the liver. The purpose of cryosurgery is to destroy all present tumors (including a margin of healthy tissue) by freezing them. The purpose of this study was to evaluate clinical outcomes after cryosurgery for hepatic malignancies.
METHODS
Freezing is performed using high pressure argon or liquid nitrogen and utilizing the Joule-Thomson effect. Two freeze-thaw cycles performed at each location have been previously documented to increase tissue destruction. Mechanisms of freezing-induced cellular destruction include intracellular and extracellular ice crystal formation, cell membrane damage, cellular dehydration, ischemic damage from thrombosed vessels, and apoptosis. Cryosurgery is performed through open placement of cryoprobes in the tumor, using laparoscopic and percutaneous approaches. The cryosurgery procedure is usually monitored with ultrasonography, computed tomography, and magnetic resonance imaging.
RESULTS
Hepatic cryosurgery was performed in 6 patients (follow-up period more than 1 year) at our hospital. We noted no local tumor recurrence, and we achieved effective treatment of hepatic malignancies.
CONCLUSION
Hepatic cryosurgery is increasingly recognized as a safe and effective treatment modality for nonresectable patients, or as a modality to be used in conjunction with liver resection.