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©2008 The WJG Press and Baishideng.
World J Gastroenterol. Mar 7, 2008; 14(9): 1430-1436
Published online Mar 7, 2008. doi: 10.3748/wjg.14.1430
Published online Mar 7, 2008. doi: 10.3748/wjg.14.1430
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 |
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 |
- Citation: Xu KC, Niu LZ, He WB, Hu YZ, Zuo JS. Percutaneous cryosurgery for the treatment of hepatic colorectal metastases. World J Gastroenterol 2008; 14(9): 1430-1436
- URL: https://www.wjgnet.com/1007-9327/full/v14/i9/1430.htm
- DOI: https://dx.doi.org/10.3748/wjg.14.1430