Two decades of experience with hepatic cryotherapy for advanced colorectal metastases.

Abstract

INTRODUCTION:

Only 15% of patients with colorectal liver metastases (CLM) are candidates for curative hepatectomy at time of diagnosis, limited by anatomical location and tumor burden. Ablative therapies may extend this. This study reports a single institution's long-term experience with hepatic cryotherapy for advanced CLM.

METHODS:

Between April 1990 and June 2009, 304 patients were curatively treated with cryotherapy. Survival was estimated by Kaplan-Meier method. Prognostic factors for survivals were determined by using univariate and multivariate analyses.

RESULTS:

A total of 293 patients were included into analysis. The median number of lesions treated per patient was three (range, 1-13). The median overall survival was 29 (range, 3-220) months. The 1-, 3-, 5-, and 10-year survivals were 87%, 41.8%, 24.2%, and 13.3%, respectively. A total of 161 patients developed intrahepatic recurrences: cryosite (23%); edge recurrence (14%); and within the liver remnant (78%). The median disease-free survival (DFS) was 9 (range, 1-220) months. The 1-, 3-, 5-, and 10-year DFS rates were 37.9%, 17.2%, 13.4%, and 10.8%, respectively. Univariate analysis identified four factors that significantly affect survival: node-positive primary tumor (p=0.001), preoperative CEA level (p<0.001), number of lesions (p<0.001), and use of neoadjuvant chemotherapy (p<0.001). However, only primary tumor nodal status was independently prognostic (hazards ratio=2.023; 95% confidence interval, 1.444-2.835; p<0.001).

CONCLUSIONS:

Hepatic cryotherapy seems to be a safe and effective ablative technique for the treatment of colorectal liver metastases and may offer long-term survival in otherwise unresectable disease.

• Authors: Keh M Ng, Terence C Chua, Akshat Saxena, Jing Zhao, Francis Chu, David L Morris
• Journal: Annals of surgical oncology (Ann Surg Oncol) Vol. 19 Issue 4 Pg. 1276-83 (Apr 2012) ISSN: 1534-4681 [Electronic] United States
• PMID: 21913018 (Publication Type: Journal Article)

Topics

• Colorectal Neoplasms (prevention & control, secondary)
• Cryosurgery
• Disease-Free Survival
• Female
• Hepatectomy (mortality)
• Humans
• Kaplan-Meier Estimate
• Liver Neoplasms (mortality, surgery)
• Lung Neoplasms (secondary)
• Male
• Middle Aged
• Neoplasm Invasiveness
• Neoplasm Recurrence, Local
• Peritoneal Neoplasms (secondary)
• Prognosis
• Survival Rate