Cryosurgery of close or positive margins after hepatic resection for
primary and metastatic hepatobiliary malignancies.
Shen P, Hoffman A, Howerton R, Loggie BW.
Department of General Surgery, Wake Forest University Baptist Medical
Center, Winston-Salem, North Carolina 27157, USA.
Obtaining a one-centimeter negative margin is an
important factor in preventing disease recurrence after surgery
for hepatic tumors. Cryotherapy of the resected edge has been used
to achieve optimal margin clearance in cases in which the alternative
would be an extended high-risk liver resection. The effect of this
technique on margin recurrence was examined. Between 1994 and 2001
a total of 56 patients underwent cryosurgery with or without resection
for primary and metastatic hepatobiliary malignancies. A 5-cm cryotherapy
lollipop probe was used to ablate surgical margins less than one
centimeter in 13 of these patients. There were seven colorectal
metastases, three hepatocellular carcinomas, and three gallbladder
carcinomas. The median size of the colorectal and hepatocellular
lesions was 3 cm (range 2-14 cm), and all gallbladder primaries
were T2 tumors. All tumors except three were located centrally in
the liver requiring cryoablation of margins at segments 4, 5, and
8. Most patients had one site frozen (n = 9) with a median target
temperature of -190 degrees C and a median of two freeze-thaw cycles.
Final pathological analysis of the resected specimens revealed nine
close (<1 cm) and four positive margins. With a median follow-up
of 16 months seven patients are alive with no evidence of disease
and six have developed recurrences with three of them dying of their
disease. Only one (8%) of the initial recurrences was at the cryoablated
margin. Cryosurgery of the resection edge facilitates liver resection
for malignant tumors when margins are close or positive. Because
disease recurrence at the cryoablated margin is low this technique
may allow more patients to undergo effective surgical treatment
of their hepatobiliary cancers.
PMID: 12206604 [PubMed - indexed for MEDLINE]