Cryoablation in patients with unresectable liver and pancreatic tumors.

Results.

Short-term results: Among the following complications of cryoablationwere noticed 2(3.3%) major (intraabdominal bleeding), and 4(6.6%) minor complications: acute pancreatitis (n = 2), wound abscess (n = 2). The bleeding were due to cracks appeared on the “ice-ball” – pancreatic tissue border (n=1). Arterial vessel was injured in the process of biopsy sampling after cryodestruction and that caused one more bleeding. Relaparotomy was performed in both cases for the purpose of haemostasis. Four patients developed ascites that was cured in 5 – 8 days therapeutically. Pain (pancreatic cancer) was decreased in 78% of patients. There was no postoperative mortality.

Long-term results: The results of cryoablation were studied in 20 patients with metastaticcolorectal cancer in the liver and 28 patients with cancer of the head of thepancreas.

Kaplan-Meier survival analysis showed in patients with colorectal MTS in the liver: 6 months. - 84%, 12 months. - 66%, 24 months. – 41%,

28 months- 36%, 36 months- 22%. Mediana – 18 months.

Kaplan-Meier survival analysis showed in patients with cancer of the head of the pancreas: 6 months. – 56%, 12 months. – 32%, 24 months. – 17%, 28 months. – 4,3%. Mediana – 8 months.

Conclusion: Cryoablation in patients with unresectable colorectal liver metastases and pancreatic head cancer in combination with chemotherapy has low morbidity and no postoperative mortality. This procedure it seems may extend long term survival rate.

Chzhao A.V.,1 Ionkin D.A.,1 Zhavoronkova O.I.,1

Vetsheva N.N.,1 Shurakova A.B., 1 Bugaev S.A.,1 Kungurtsev S.V.2

(1 A.V. Vishnevsky Institute of Surgery, Moscow, Russia2Innovative company BIOMEDSTANDART, Moscow, Russia)

 

Aim: to analyzed the results of cryoablation in patients with unresectablecolorectal liver metastases (CLM) and pancreatic cancer.

Materials and methods: Since 2007, cryoablation under the guidence of intraoperative ultrasound was performed in 60 pts. (24 pts.- CLM, 36 - pancreatic head cancer). Mean age was 54±3years. Size of lesions in liver ranged from 1.5 to 9.0 cm, the number of lesions - from 1 to 10 (4 ± 3). Size of lesions in the pancreas ranged from 2.5 to 10 cm in length.

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Fig.1. Apparatus «KRIO-MT»

Time of procedures ranged from 2 to 5 minutes at T° from -175 to -186°C. Number of sessions at one lesion was 1 - 5.

Cryoablation in combination with hepaticojejunoanastomoses was perfomed in 84%, with gastrojejunostomy – in 32% of pts. In 2 patients with CLM cryoablation follow by percutaneous alcoholization postoperatively. Neoadjuvant chemotherapy received 12(33.3%) pts.with pancreatic head cancer and 18 (75%) with CLM. All of patients had adjuvant chemotherapy. 5 (20.8%) pts. with CLM postoperatively have got transarterial chemoembolization.

Fig.6. MRI 24 hours after ablation

Fig.3. CKT. Cancer of the pancreas Fig.4(a,b) Intraoperative view: before (a) and after cryoablation (b).

a. b a. b c

Fig.5(a,b,c). The pancreatic ultrasound imaging before (a), during- (b) and after procedure (c)

a. b. c. a. b. c. d.

Fig.7. MRI. Colorectal liver metastases Fig.8 (a,b,c) . Intraoperative view: before - (a), during- (b) and just after cryoablation (c)

Fig.9 (a,b,c,d) . The liver ultrasound imaging during- (a,b) and after the freezing (c,d)

Fig.11. Kaplan-Meier survival analysis showed in patients with pancreatic cancer.

Fig 10. Kaplan-Meier survival analysis showed in patients with MTS in the liver

Fig.2. Spongy-parous applicators TiNi