Percutaneous cryosurgery for the treatment of hepatic colorectal metastases

Table 1 Characteristics of patients with hepatic colorectal metastases

Total cases	326
Median age (range)	54 (32-84)
Male/Female (cases)	243/83
No. of tumors (cases)
1	125 (38.3%)
2	105 (32.2%)
3	65 (19.9%)
More	31 (9.5%)
Tumor size (cases)
< 3 cm	95 (29.1%)
3-5 cm	124 (38.0%)
> 5 cm	107 (32.8%)
Development of metastases
Synchronous (cases)	65 (19.9%)
Metachronous (cases)	261 (80.1%)
Colorectomy to detection of metastases (mo)	12 (0-42)
Metastases detected to cryosurgery (mo)	4 (1-14)
Colorectomy to cryosurgery (mo)	16 (3-52)
Precryosurgery chemotherapy(cases)	216 (66.3%)
Precryosurgery CEA (mg/dL)	11.2 (0.3-1422)

Table 2 Sites of repeat cryosurgery

Cryosurgery sites	No. of patients	Procedures of repeat cryosurgery
Liver only	105	142
Liver and lungs	40	52
Liver and pancreas	6	6
Total	151	200

Table 3 Recurrence pattern at death or latest follow-up

	Cases n (%)	% of all cases
Total recurrence	136 (100)	41.7
Liver only	83 (61.0)	25.5
Cryosite only	7 (5.1)	2.1
Liver other than cryosite only	62 (45.5)	19.0
Cryosite and remaining areas	14 (10.2)	4.3
Extrahepatic metastases only	34 (25.0)	10.4
Lungs	10 (7.4)	3.1
Brain	2 (1.4)	0.6
Bone	4 (2.9)	1.2
Lymph nodes	11 (8.1)	3.4
Peritoneum	3 (2.2)	0.9
Multiple areas	4 (2.9)	1.2
Liver and some extrahepatic areas	19 (13.9)	5.8
Liver and lungs	8 (5.8)	2.8
Liver and pancreas	2 (1.4)	0.7
Liver and lymph nodes	5 (3.7)	1.7
Liver and bone	1 (0.7)	0.3
Liver and others	3 (2.2)	1.0

Table 4 Survival based on patient characteristics and tumor features

	Median survival (mo)	Survival rate (%)
		1 yr	3 yr	5 yr
All patients	29	78	41	23
Tumor size
≤ 3 cmb	39	92	64	34
> 3 cm	21	70	41	21
Tumor number
< 3	38	81	40	20
> 3	40	78	41	22
Tumor location
Right lobeb	33	87	57	39
Left lobe	25	72	39	21
Bilobar	17	65	32	14
Detection of metastases
Synchronous	30	76	43	24
Metachronous	29	81	41	21
Metastases detected to cryosurgery
< 3 mo	31	74	41	22
> 3 mo	29	79	42	23
Pre-cryosurgery chemotherapy
Yes	30	75	40	24
No	29	77	41	21
Pre-cryosurgery CEA
< 100 ng/dLb	44	90	57	41
> 100 ng/dL	20	73	39	17
Cryosurgery procedure
Once	21	70	34	19
Twiceb	38	87	55	36
Thriceb	39	90	54	34
More	12	69	25	13
Post-cryosurgery TACE
Yesb	38	84	57	47
No	18	76	25	15

^bP < 0.01 Survival of patients with tumor size ≤ 3 cm vs > 3 cm, tumor location right lobe vs left lobe or bilobar, pre-cryosurgery CEA < 100 ng/dL vs > 100 ng/dL, twice or thrice procedures vs once or more procedures, and TACE vs no TACE after cryosurgery.

Table 5 Adverse effects within 30 d after cryosurgery

Adverse effects	No. of patients	%
Minor
Pain	103	31.6
Fever (> 38°C)	108	33.1
Increased liver enzymes	124	38
Thrombocytopenia	58	17.8
Pleural effusion	20	6.1
Major
Hepatic bleeding	5	1.5
Cryoshock	1	0.3
biliary fistulae	3	0.9
Liver failure	1	0.3
Renal insufficiency	5	1.5
Liver abscess	3	0.9
Acute myocardial infarction and severe arrhythmias	2	0.6

Table 6 Results of hepatic cryosurgery for colorectal metastases

Authors	No. of cases	Mode of cryo	Operative mortality (%)	Associated therapy (No. of patients)	Follow-up (mo)	Median survival (mo)	Survival (%)
							1 yr	2 yr	3 yr	5 yr
Korpan 1997[22]	63	OC	0	Resection	6-120				60	44
Wallace 1999[23]	137	OC	0	Resection	14 (1-60)	23	86	47	29
Weaver 1995[15]	47	OC	4	Chemo	26 (24-57)			62
Ruers 2001[21]	30	OC		Resection	26 (9-73)	32	76	61
Cha 2001[20]	21	OC		Resection	28 (18-51)				701
Bilchik 2001[19]	153	OC		Chemo		28
Goering 2002[18]	42	OC		Resection		45	82		55	39
Kerkar 2004[14]	982	OC			54 (9-98)	33	81	62	48	28
Jungrai Thmayr 2005	17	OC	0		23 (2-65)	21	52	36	10	5
This study 2007	326	PC	0	TACE	32 (7-62)	29	78	62	41	23

¹Thirty mo survival;

²Including 56 cases of hepatic colorectal metastases. Cryo: Cryosurgery; OC: Operative cryosurgery; PC: Percutaneous cryosurgery.