Cryoablation of hepatic neoplasia

Cryotherapy can destroy localised hepatic tumours while sparing normal liver tissue if some elementary rules are followed. Due to advances in instrumentation, cryogenic lesions can now be reliably produced. For the safe placement of cryoprobes, intraoperative ultrasound (US) is indispensable, Synergistic freezing with several probes is recommended for tumours > 2-3 cm. The ice-front should exceed the diameter of the lesion by a minimum of 1 cm. Tissue temperatures of -50 degrees C are required. The results from our first 18 patients (8/93-7/96) with unresectable liver metastases are encouraging. 55% of the patients treated with open cryosurgery were alive at a follow-up of 24 months. In contrast to the open approach, five of 13 lesions in patients treated percutaneously could not be completely destroyed. Due to the high probability of extrahepatic disease in liver metastases, it seems unlikely that a percutaneous or laparoscopic approach will be standard in the future. Nevertheless, cryoablation of unresectable hepatic neoplasia widens the treatment options for these patients.