Cryosurgical Treatment of Tumors of the Liver

and Pancreas

Patyutko Y.I., Podluzhny D.V., Gakhramanov A.D.

Russian Cancer Research Center,

Moscow,

2013

Cryosurgical Treatment for Tumors of the Liver and Pancreas of 64 patients received

Cryosurgical device «CRYO-МТ»

Cryotherapy techniqueCryosurgery is a direct application of extreme cold on the front surface of the tumor.

The temperature was determined in the range from -180°C to -190°C, during a single procaedure exposure ranged from 7 to 25 minutes, diameter cryoapplicator varied from 20 to 50 mm

Cryotherapy was performed in one, two or three positions. In some patients, cryotherapy was performed in two cycles with complete thawing and recryodestruction in the same place.

Applicator was used to perforation and for destruction of tumors located deep in the organ parenchyma.

Dining cryosurgery1. Cryosurgery tumor as an independent method of treatment. Apply with

unresectable tumors of the pancreas and liver

2. Cryosurgery plus radical surgery.

3. Cryosurgery plus radiotherapy.

4. Cryosurgery plus chemotherapy. Cryodestruction supplemented standard chemotherapy schemes.

5. Cryosurgery in place of the removed tumor. It is performed as a non-radical surgery to reduce the possibility of the local recurrence.

6. Cryosurgery before mobilization pancreas. It is used to eliminate the dissemination of the tumor after mechanic damaged during mobilization. Then a radical operation is performed.

Cryosurgery as an independent method of

treatment.

• It was used in case of non-resectable liver tumors, and pancreas.

• This method was performed in 24 patients with the pancreatic tumors and in 4 patients with liver tumors

Analgesic effect of different treatment methods unresectable pancreatic tumors

number of patients with analgesic effect

Cryo-surgery Cryo-surgery+ radiotherapy

Cryo-surgery + chemotherapy

Incomplete analgesia 50% 18,2% 30%

Complete analgesia 50% 72,8% 70%

Survival of patients with ductal pancreatic adenocarcinoma undergoing various treatment options.

method of treatment localization median 1 year 2 year

Distal pancreatectomyn = 23

distal 7,5 мес. 9% 0%

Cryosurgeryn=24

distal 5,8 мес. 5,17% 0%

Cryosurgery + radiotherapyn=10

distal 6,7 мес. 0% 0%

Cryosurgery + chemotherapy n=12

distal 9,0 мес. 22,2% 18,2%

Radiotherapy n=3

distal 4,6 мес. 0% 0%

Radiotherapyn=21

head 8 мес. 19% 4,7%

Symptomatic treatmentn=11

Аll 3,9 мес. 0% 0%

Cryosurgery plus operation

When bilobar tumor liver disease liver resection is performed on the side of larger lesions and cryotherapy tumor nodules in the remaining lobe of the liver.

Or resection of the pancreas and liver metastases cryosurgery.

Performed in 23 patients.

Cryosurgery before mobilization of the pancreas.

Performed to avoid dissemination of the tumor after mechanic damage during

mobilization. Then, the radical operation.

Cryo + Distal pancreatectomy2 patients

Cryo + pancreatoduodenal ectomy2 patients

Cryotherapy in place of the removed tumor.

Performed with non-radical surgery to reduce the possibility of the pancreatic tumors

local recurrence

Distal pancreatectomy+ cryo

8 patients

Pancreatoduodenalectomy + cryo

4 patients

Hepatectomy+ cryo

3 patients

Mortality rate 4.9%Causes of deaths:

- Acute renal failure,

- Acute cardiovascular failure,

- Bleeding from acute gastric ulcers.

Cryodestruction of the liver tumors and the pancreatic tumors is a safe and

effective procedure. The advantages of this method are biological inertness of

cryonecrosis hearth and easy technique.