CRYOSURGERY OF LIVER TUMORS

Background. The incidence of both malignant and benign liver tumors is steadily increasing. Because signs and symptoms of liver cancer do not usually appear until the late stages, its curable rate remains low. To improve the treatment outcomes, preoperative chemoembolization, sclerobliteration of the vessels and cryoexposure are used. In cases with benign liver tumors, vascular embolization, various types of coagulation and ultra-low temperatures are applied to reduce blood loss and to prevent disease recurrence. Objective: to analyze the results of cryosurgery for malignant and benign liver tumors. Material and methods. The original cryosurgical equipment capable of producing a temperature of -196о C was used. It comprises a cryoultrasonic scalpel, cryodestructor and cryoapplicators from porous titanium nickelide adapted for laparoscopic surgery. Cryosurgery was performed on 81 patients with liver cancer, 6 patients with Klatskin tumor, 141 patients with a hemangioma, and 9 patients with hepatic adenoma. Results. Out of 81 patients with liver cancer, 9 underwent extended hemihepatectomy using a cryoultrasonic scalpel, while the remaining patients underwent liver resection using a conventional scalpel with cryodestruction of the liver stump. Decrease in blood loss by 25 % due to freezing of vessels up to 1 mm was noted. Four patients died after resection of the liver (5.1 %). Tumor recurrence was observed in 3.8 % of the patients. The 1-, 3, and 5-yaer survival rates were 74.6 %, 52 %, and 40 %, respectively. In cases with hemangiomas, 20 cryoresections were performed. There were 91 resections using a conventional scalpel with cryodestruction of the stump and 22 laparoscopic cryodestructions of small hemangiomas (3–5 cm). The use of cryoinstruments reduced intraoperative blood loss and caused aseptic necrosis followed by sclerosis of small hemangiomatous nodes. After resection of the liver, 3 people died (2.7 %), 1 relapse occurred. Concerning liver adenoma, 9 hemihepatectomies with cryodestruction of the stump were performed. There were no lethal outcomes and relapses of the disease. Conclusion. Cryosurgery for malignant and benign liver tumors can be performed as: 1) cryoresection; 2) conventional resections with cryodestruction of the stump 3) cryodestruction of small hemangiomas and metastatic nodes, including laparoscopic approach. The use of ultra-low temperatures reduces blood loss and improves surgical ablation outcomes.

1. Granov A.M., Tyutin L.A., Pozdnyakov A.V. Modern possibilities of radiation diagnosis of liver cancer. Questions of oncology. 2008; 54 (4): 410–416. [in Russian]

2. Brazhnikova N.A., Tshay V.F. Features of liver cancer in chronic opisthorchiasis. Annals of surgical hepatology. 2008; 13 (3): 85–87. [in Russian]

3. Merzlikin N.V., Alperovich B.I., Brazhnikova N.A., Tshay V.F., Sotnikov A.A., Komkova T.B., Tolkaeva M.V. Manual on surgery of focal parasitic liver diseases. Tomsk, 2014; 468. [in Russian]

4. Bagnenko S.S., Trufanov G.E., Zheleznyak I.S. Magnetic resonance imaging in the diagnosis of focal liver lesions. Annals of surgical hepatol ogy. 2016; 21 (3): 64–69. [in Russian]

5. Afanasyev S.G., Tuzikov S.A. Inoperable liver tumors (literature review). Siberian Journal of Oncology. 2006; 1: 49–54. [in Russian]

6. Kotiv B.N., Alentiev S.A., Dzidzava I.I., Ivanusa S.Ya., Lazutkin M.V., Slobodyanik A.V., Muzharovsky A.L., Sveklov D.A. Preoperative embolization of the portal vein in the combined treatment of malignant neoplasms of the liver. Annals of surgical hepatology. 2016; 21 (3): 12–19. [in Russian]

7. Granov A.M., Davydov M.I. Interventional radiology in oncology. SPb., 2013. 560. [in Russian]

8. Granov D.A., Polikarpov A.A., Sergeev V.I., Tarazov P.G. Preopera tive embolization of the portal vein and chemoembolization of the hepatic artery in the combined treatment of patients with malignant liver tumors. Annals of surgical hepatology. 2016; 21 (3): 20–24. [in Russian]

9. Zagainov E.M., Seregin A.A., Zaitsev A.I., Komarov D.V., Sharabrin E.G., Rykhtik P.I., Kukosh V.M., Zagainov V.E. Modern methods of stimulating the vicar hypertrophy of the liver fragment before extensive re section: an evaluation of the effectiveness and ways to improve the results. Annals of surgical hepatology. 2016; 21 (3): 25–33. [in Russian]

10. Melekhina O.V., Efanov M.G., Alikhanov R.B., Tsvirkun V.V., Kulezneva Yu.V., Starostina N.S., Kim P.P., Kazakov I.V., Vankovich A.N. Surgical methods of preventing hepatic failure after extensive liver resection. Annals of surgical hepatology. 2016; 21 (3): 47–55. [in Russian]

11. Schnitzbauer A.A., Lang S.A., Goessmann H., Nadalin S., Baumgart J., Farkas S.A., Fichtner-Feigl S., Lorf T., Goralcyk A., Hörbelt R., Kroemer A., Loss M., Rümmele P., Scherer M.N., Padberg W., Königsrainer A., Lang H., Obed A., Schlitt H.J. Right portal vein ligation combined with in situ splitting induces rapid left lateral lobe hypertrophy enabling 2 staged extended right hepatic resection in small for size setting. Ann Surg. 2012 Mar; 255 (3): 405–14. doi: 10.1097/SLA.0b013e31824856f5.

12. Schadde E., Schnitzbauer A. A., Tschuor C., Raptis D.A., Bechestein W.O., Clavien P.A. Systematic review and meta analysis of feasibility, safety, and efficacy of a novel procedure: Associated liver partition and Portal Vein ligation for staged. Hepatectomy. Ann Surg Oncol. 2015; 22 (9): 3109–3120. PMID: 25448799. doi: 10. 1245/s10434 014 4213 5.

13. Al’perovich B.I. Surgery of the liver. Moscow, 2010. 352. [in Russian]

14. Zhao A.V., Ionkin D.A., Zhavoronkova O.I., Chugunov A.O., Kovalenko Yu.A., Kungurtsev S.V., Pavlov V.N., Semenov V.Yu. The possibility of using cryodestruction in malignant neoplasms of the liver. Materials of the II International Scientific and Practical Conference «Cryosurgery. Modern methods and innovative technologies». SPb., 2012; 5768. [in Russian]

15. Al’perovich B.I., Merzlikin N.V., Komkova T.B., Salo V.N., Gunter V.E., Paramonova L.M., Kungurtsev S.V. Cryosurgical operations for liver and pancreas diseases: a guide for doctors. Moscow, 2015. 240. [in Russian]