Cryoablation as a method for extending indications for liver resection – results

Introduction: Liver resection is the method of choice in the treatment of patients with primary and metastatic liver tumours. However, only 10-20% of patients with diagnosed malignant liver tumour can be treated operatively with curative intention. Liver resection can be performed in patients with liver tumour (tumours), localised in one of the liver lobes, with the exception of neoplastic infiltration of vascular structures and/or extrahepatic metastases. Patients either with tumours localised in both liver lobes or with multiple and disseminated changes could only be referred for palliative treatment. One of the most efficient methods of treatment of patients with unresectable liver tumours is cryoablation. Cryoablation can be performed during laparotomy as the main procedure or in addition to liver resection with tumourous changes. Aim: The aim of this study was to review the indications, clinical presentation and the results of intraoperative cryoablation in primary and secondary liver tumours. Materials and methods: Cryoablation was performed in 54 patients with liver tumours – in 33 patients as definitive treatment and in the remaining 21 in combination with liver resection. Cryoablation was carried out using CRYO6 System (ERBE), with liquid nitrogen as a cooling medium. 3 cryoprobes and flat applicators were used and the freezing temperature was set at –190°C. Freezing progress was checked by intraoperative ultrasound examination. Results: There were no deaths in the early postoperative period recorded among patients who underwent cryoablation either intraoperatively or complementing liver resection. The time of procedure varied from 120 to 300 minutes and on average was 180 minutes. In the early postoperative period there was a transient rise in levels of AspAt/AlAt and concentration of bilirubin and clotting disturbances which on average normalized within 7 days after the procedure. In 9 patients complications which may have resulted from cryoablation arose. These were: bleeding from the tumour, abscess in cryoablation site, pleural exudate, liver insufficiency. In the observation period of 12-40 months 5 patients died. In 13 patients recurrence of neoplastic disease was observed. The survival time of these patients varied from 11 to 26 months. The research on survival time will be continued. Conclusions: Palliative cryoablation of malignant liver tumours can be performed as the definitive treatment in patients who do not meet the criteria for liver resection. In some patients with primary and metastatic liver tumours liver resection combined with cryoablation is safe and effective treatment and extends the number of patients treated surgically with curative intent.