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Laparoscopic Cryoablation of Hepatic Metastases
David A. Iannitti, MD;
B. Todd Heniford, MD;
Jonathan Hale, MD;
Sharon Grundfest-Broniatowski, MD;
Michel Gagner, MD
Arch Surg. 1998;133:1011-1015.
Objective To evaluate the feasibility of laparoscopic cryoablation for the management of hepatic metastases.
Design Retrospective review.
Setting Tertiary referral center.
Patients Nine patients were evaluated by laparoscopy for planned laparoscopic cryoablation of hepatic metastases at The Cleveland Clinic Foundation, Cleveland, Ohio, from April 1996 to May 1997.
Results Laparoscopic exploration revealed diffuse extrahepatic disease not identified by preoperative studies in 2 patients. The remaining 7 patients underwent 9 cryotherapy sessions. During 4 of the cryotherapy sessions, ultrasonography demonstrated unrecognized additional treatable hepatic lesions. An average of 3 lesions (range, 2-5) were treated. Operative time averaged 3.5 hours with a mean intraoperative blood loss of 235 mL. One patient had significant intraoperative hemorrhage requiring conversion to open hepatic resection for bleeding control. Eight of the 9 patients tolerated normal diets and ambulated independently on the first postoperative day. Following cryotherapy, 4 of the patients developed fever without an infectious source. One patient developed a postoperative bile leak requiring percutaneous biliary stenting. Postoperative hospital stay averaged 4.5 days (median, 4 days; range, 2-14 days). At a mean follow-up of 9 months, 4 of the 7 patients treated are alive without evidence of disease, 2 are alive with disease, and 1 patient with a pancreatic primary tumor has died of disease.
Conclusions Laparoscopy with laparoscopic ultrasonography is a useful tool in evaluating patients with hepatic metastases. Laparoscopic cryoablation is feasible and may result in lower postoperative morbidity in patients receiving aggressive treatment for inoperable hepatic metastases.
From the Departments of General Surgery (Drs Iannitti, Heniford, and Grundfest-Broniatowski) and Radiology (Dr Hale), The Cleveland Clinic Foundation, Cleveland, Ohio; and Division of Laparoscopic Surgery, Mount Sinai Medical Center, New York, NY (Dr Gagner).
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