Reduction in Recurrence Risk for Involved or Inadequate Margins With Edge Cryotherapy After Liver Resection for Colorectal Metastases
Thomas Gruenberger, MD;
Jean-Luc Jourdan, MD;
Jing Zhao, MMS;
Julie King, MPH;
David Lawson Morris, MD,PhD
Arch Surg. 2001;136:1154-1157.
Hypothesis The usefulness of additional edge cryotherapy after liver resection for liver metastases from colorectal cancer to improve involved or inadequate (less than 1 cm) margins is uncertain.
Design Retrospective analysis of prospectively collected data.
Setting Department of surgery at a university hospital.
Patients Eighty-six consecutive patients with hepatic metastases from colorectal cancer in whom we applied additional edge cryotherapy to involved or inadequate margins. This group was compared with 134 patients who underwent resection without edge cryotherapy (control group) during the same period.
Intervention Potentially curative treatment was achieved by adding edge cryotherapy to insufficient resection sites in patients not eligible for further resection.
Main Outcome Measures Edge recurrence rate in the study group; validation of an additional treatment to improve curative resectability; and comparison of morbidity and local recurrence rates with the control group.
Results At a median follow-up of 39 months, 47 patients were alive and 39 had died. Local recurrence at the resection site was diagnosed in 9 patients (10%), of which 7 occurred in patients with involved margins and 2 in patients with resection margin less than 1 cm. Thirty-six patients (42%) experienced recurrence in the remnant liver. Extrahepatic recurrence occurred in 38 patients (44%), the lungs being the most common site (22 patients [26%]).
Conclusions Edge cryotherapy is a potent additional surgical treatment option in patients with liver metastases from colorectal cancer. The percentage of patients who can be treated for cure can be increased, especially if complex liver surgery is demanded.
From the Department of Surgery, University of New South Wales, St George Hospital, Kogarah, Sydney, Australia.
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