Cryosurgery for Hepatic Malignancies

It was estimated that there would be 131,200 new cases of colon and rectal cancer in 1997 in the United States and 54,900 deaths due to colon and rectal cancer.1 Ninety percent of patients who die from colorectal cancer have liver metastases.2 The liver is the most prevalent site of first or only recurrence.3 Liver metastases occur in 40–75% of patients with colorectal cancer, but only 10–30% have metastatic disease limited to the liver.4,5 Surgical resection of hepatic metastases remains the treatment of choice when feasible, but only 5–10% of patients are considered candidates for liver resection.6,7 Patients with limited liver metastases from colorectal cancer who do not undergo hepatic resection rarely survive more than 2 years after diagnosis.8,9 Five-year survival rates of 25–35% have been reported in patients who have undergone hepatic resection of colorectal metastases.10,11 Unfortunately, at least 75% of patients with limited liver-only metastases are not candidates for surgical resection.12 Patients who have multiple metastases involving both the right and left lobes of the liver, metastatic lesions in proximity to major blood vessels or biliary structures where a 1-cm margin of clearance cannot be achieved, or more than three or four liver metastases have usually been considered to have unresectable lesions and do not qualify for standard hepatic surgical resection.8,10,13,14