Abstracts
1999 Digestive Disease Week

# 2119 A 5-YEAR INSTITUTIONAL EXPERIENCE WITH HEPATIC CRYOSURGERY AND HEPATIC ARTERY CHEMOTHERAPY (FUDR) FOR UNRESECTABLE COLORECTAL METASTASES.
A J Bilchik, T Sarantou, L J Foshag, D M Rose, S L Stern, P I Haigh, K Chu, K P Ramming, John Wayne Cancer Instute, Santa Monica, CA

Most patients with metastatic colorectal cancer are not amenable to resection and do not respond to adjuvant therapy. This study evaluated our 5-year experience using hepatic cryosurgery to treat patients with hepatic colorectal metastasis refractory to systemic chemotherapy (progression documented by computed tomography [CT] and increased serum level of carcinoembryonic antigen [CEA]). Between July 1992 and July 1997, 121 patients underwent cryosurgery: 51 females and 70 males, ages 30-76 years (median 60). Patients were evaluated preoperatively with spiral CT scan and intraoperatively with ultrasound. Lesions were frozen with liquid nitrogen delivered by insulated probes for 15 minutes at -190oC. The iceball was monitored with real-time ultrasound. Multiple probes were used to freeze lesions larger than 5 cm. One to fifteen lesions were frozen (mean 3.4 and median 3; mean size 3.1 cm). Patients with more than 4 lesions also underwent hepatic artery pump placement for regional chemotherapy (FUDR) (n=37). There was one operative death. Average ICU and hospital stays were 1.5 and 6 days, respectively. Median follow-up from surgery was 13 months (1-58 months). Mean reduction in CEA levels was 68% overall, 80% for cryosurgery alone, and 56% for cryosurgery plus FUDR. Survival rates are shown below. Overall median survival was 29.1 months. Patient with >4 lesions who received FUDR had a similar survival to those with fewer lesions. These data indicate that regional chemotherapy may improve survival in patients with large or multiple lesions. Crysosurgery is an effective alternative treatment for patients with unresectable hepatic metastases not responsive to chemotherapy. Survival Rates

From date of cryosurgery			From date of hepatic metastasis
Year	Cryo + FUDR	Cryo Alone	Cryo + FUDR	Cryo Alone
1	63%	70%	78%	91%
2	34%	35%	49%	62%
3	18%	14%	30%	41%

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