Adam R, Akpinar E, Johann M, Kunstlinger F, Majno P, Bismuth H
Liver Transplant Unit, Hôpital Paul Brousse, Université Paris Sud, Villejuif, France.
Ann Surg. 1997 Jan;225(1):39-8; discussion 48-50. doi: 10.1097/00000658-199701000-00005.
The authors evaluate the results of cryosurgery in malignant liver tumors.
The outcome of primary or secondary liver tumors is poor when resection can not be achieved. Encouraging results of cryosurgery have been reported in unresectable liver tumors, but this treatment needs further evaluation of its efficacy in homogeneous groups of patients.
From 63 patients with malignant liver tumors with various histology treated by cryosurgery in a 2.5-year period, the authors evaluated the results of 34 patients with nonresectable hepatocellular carcinoma (9 patients) or nonresectable metastases from colorectal cancer (25 patients). Cryosurgery was used either as a single treatment (4 hepatocellular carcinomas, 5 metastases) or in association with liver resection (5 hepatocellular carcinomas, 20 metastases). Systemic chemotherapy was used routinely before surgery and after surgery.
There was no intraoperative mortality. Mortality within 2 months was 3% and was unrelated to the procedure. Postoperative morbidity consisted of one sterile fluid collection and one biliary fistula (8%). At a mean follow-up of 16 months, (range, 2-27) local recurrence rate was 0% for hepatocellular carcinoma and 44% for metastases. Cumulative survival at 24 months was 63% and 52%, respectively, with 6 patients (67%) and 5 patients (20%) currently disease free. In the group of patients with metastases, survival was related to the size of the treated tumor (p = 0.06) and the absence of residual disease (p = 0.03).
Cryosurgery is safe and increases the number of patients with unresectable liver malignancies in whom surgery can aim at eradicating the tumor. Local recurrence is observed more frequently for metastases than for hepatocellular carcinoma. The benefit in survival is related to the complete treatment of the tumoral disease.
作者评估冷冻手术治疗恶性肝肿瘤的结果。
当无法进行肝肿瘤切除时，原发性或继发性肝肿瘤的预后较差。冷冻手术治疗不可切除肝肿瘤的结果令人鼓舞，但该治疗方法在同组患者中的疗效仍需进一步评估。
在2.5年期间，对63例接受冷冻手术治疗的不同组织学类型的恶性肝肿瘤患者进行研究，作者评估了34例不可切除肝细胞癌（9例）或不可切除结直肠癌转移瘤（25例）患者的治疗结果。冷冻手术可单独使用（4例肝细胞癌，5例转移瘤）或与肝切除术联合使用（5例肝细胞癌，20例转移瘤）。术前和术后常规使用全身化疗。
无术中死亡。2个月内的死亡率为3%，与手术操作无关。术后并发症包括1例无菌性积液和1例胆瘘（8%）。平均随访16个月（范围2 - 27个月），肝细胞癌的局部复发率为0%，转移瘤为44%。24个月时的累积生存率分别为63%和52%，目前分别有6例（67%）和5例（20%）患者无疾病。在转移瘤患者组中，生存率与治疗肿瘤的大小（p = 0.06）和无残留疾病（p = 0.03）有关。
冷冻手术安全，增加了不可切除肝恶性肿瘤患者的手术切除机会，手术目的是根除肿瘤。转移瘤比肝细胞癌更易观察到局部复发。生存获益与肿瘤疾病的完全治疗有关。
