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Thanjavur S. Ravikumar, MD; Robert Kane, MD; Blake Cady, MD; Roger L. Jenkins, MD; William McDermott, MD; Gary Onik, MD; Melvin Clouse, MD; Glenn Steele, Jr, MD

Arch Surg. 1987;122(4):403-409.

Abstract
• We utilized cryosurgery with intraoperative ultrasound (IOUS) monitoring in ten patients to treat multiple unresectable hepatic metastases from colorectal carcinoma. The liver was exposed at laparotomy, and tumors were subjected to three cycles of freezing (eight minutes each) and thawing. Freezing was monitored by IOUS, which visualized frozen tumor as a hyperechoic rim with posterior acoustic shadowing. Frozen normal liver appeared hypoechoic after thawing compared with normal unfrozen liver. There were no significant complications. The follow-up ranged from four months to 17 months (median, 7.5 months). Tumor response was documented by pathologic findings (coagulative necrosis), progressive fall of carcinoembryonic antigen levels, and computed tomographic scan evidence of necrosis and shrinkage of tumor. One patient underwent repeated laparotomy five months after cryosurgery and had the frozen lesions resected; there was no residual tumor. This study establishes the technical feasibility and antitumor response of hepatic cryosurgery and the use of IOUS for precise localization and monitoring of cryoablations.

(Arch Surg 1987;122:403-409)

Author Affiliations
From the Departments of Surgery (Drs Ravikumar, Cady, Jenkins, McDermott, and Steele) and Radiology (Drs Kane, Onik, and Clouse), New England Deaconess Hospital, Harvard Medical School, Boston.

Footnotes
Accepted for publication Jan 5, 1987.

Read before the 67th Annual Meeting of the New England Surgical Society, Dixville Notch, NH, Sept 26, 1986.

Reprint requests to Department of Surgery, New England Deaconess Hospital, Suite 3A, 110 Francis St, Boston, MA 02215 (Dr Ravikumar).

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