Hepatic Cryotherapy for Cancer: A Reviewand Critique

Background: Wedge or other nonanatomic hepatic resections, performed in an attempt to spare functional parenchyma, often are not accomplished with clear resection margins and may be complicated by hemorrhage from the depth of the resection. Study Design: The current study describes a technique of cryoassisted hepatic resection that allows for controlled resection with well-defined margins. The early experience in managing 16 tumors in 13 patients is reported. Results: A cryoprobe is inserted into the tumor and freezing performed to a predetermined resection margin using ultrasound control. The ice ball, so formed, is then maintained and excised. The management of these 13 patients was associated with one intraoperative and two postoperative complications, including a death of a patient with cirrhosis who had infected ascites and died as a result of hepatic failure. Conclusions: Cryoassisted hepatic resection seems to be safe and allows resection with good tumor clearance and maximal preservation of functional parenchyma.