Cryosurgical Ablation of Colorectal Metastasis to the Liver

Abstract

Management of liver metastases from colorectal carcinoma requires knowledge of treatment results that can be obtained from systemic chemotherapy, regional chemotherapy, and surgical resection. A large percentage of patients with liver metastases are not candidates for surgical resection because of the presence of centrally placed tumors, bilobar tumors, or coexisting medical problems that might preclude the risk of major liver resection. Cryosurgery is a novel technique that employs a hollow probe with circulating liquid nitrogen to achieve tissue and tumor freezing for tumor control. This report summarizes a case of a 70-year-old patient with a centrally placed metastasis at the interlobar fissure. Cryosurgery requires the simultaneous use of intraoperative ultrasound to guide insertion of the probes and monitor the freezing process to ensure a 1-cm margin of cryoablation. Cellular damage occurs through direct tissue freezing and indirect vascular thrombosis. A review of current literature on cryosurgery provides evidence that 5-year survival may approximate the results of surgical resection. Therefore, this novel technique offers the potential for long-term tumor control in patients with unresectable colorectal liver metastases resulting from bilobar disease, centrally placed tumors, or coexisting medical problems that might otherwise preclude a major resection.