0000000000061952
AUTHOR
David L. Morris
Bile Duct Warmer in Hepatic Cryosurgery—A Pig Liver Model
Freezing of the common bile duct resulted in injury, stenosis, or perforation of the bile duct in a dog model. Biliary cutaneous fistulas and bile leaks are reported as complications of hepatic cryosurgery in man. In an ex vivo pig liver model we compared freezing close to the bile duct with and without warming the bile duct with warmed saline solution via an inserted catheter ("bile duct warmer"). The recorded temperatures at the outer wall of the bile duct were -50 degrees C after 10 min of freezing without and 5. 8 degrees C with the use of the warmer (P0.001, two-way ANOVA). The bile duct warmer system may be a simple and inexpensive device in reducing perioperative morbidity after hepa…
Die Kryotherapie von Lebermetastasen des colorectalen Carcinoms
Mit 55.000 Todesfallen war das colorectale Carcinom 1995 die dritthaufigste malignombedingte Todesursache in den USA (Wingo et al. 1995). Lebermetastasen sind bei 15–25% der Patienten bei Diagnose des Primartumors vorhanden, und weitere 20% entwickeln Lebermetastasen im weiteren Krankheitsverlauf (Ballantyne und Quin 1993). Nach Resektion isolierter colorectaler Lebermetastasen sind in zahlreichen Publikationen 5-Jahres-Uberlebensraten von 20–50% bei vertretbarer perioperativer Morbiditat (23%) und Letalitat (4,7%) angegeben worden (Ballantyne und Quin 1993, Seifert und Junginger 1996). Allerdings besteht nur bei maximal 25% der Patienten mit colorectalen Lebermetastasen technische Resektab…
Resection with cryotherapy of colorectal hepatic metastases has the same survival as hepatic resection alone.
Abstract Background Hepatic resection is well established as a potentially curative treatment for hepatic colorectal cancer metastases. However, only a small proportion of patients with liver metastases are suitable for resection because they either have extrahepatic disease, or the extent and/or the distribution of their hepatic disease would make excision impossible. We have previously described the use of cryotherapy for inadequate resection margins and lesions in the remaining lobe of the liver. Combining such cryodestructive techniques with resection offers the possibility of increasing the proportion of patients to whom potentially curative treatment can be offered. The aim of this st…
Der Metastasendurchmesser ist entscheidend für das lokale Behandlungsergebnis nach Kryotherapie colorectaler Lebermetastasen
In a retrospective analysis we aimed to assess the incidence of local recurrence at the cryosite as well as possible prognostic indicators for the disease-free interval at the cryosite following hepatic cryotherapy for non-resectable colorectal metastases. At a median follow-up of 22 months, 66 of 85 patients had developed tumor recurrence, involving local recurrence at the cryosite in 28 patients, with cryoablated metastases of >3 cm being associated with shorter disease-free intervals at the cryosite. Improvements in probe placement and monitoring of the freezing process are required to allow successful treatment of large liver metastases.
Cryoablation of Human Colorectal Cancerin Vivoin a Nude Mouse Xenograft Model
Abstract Objective: To establish the minimum required temperature in cryoablation of human colorectal cancer cell lines grown as subcutaneous tumors in mice. Methods: Male nu/nu nude mice were inoculated by a sc injection of 1 × 10 6 LoVo ( n = 30) or C170 ( n = 32) cells. After 2 weeks the tumors were frozen using a 3-mm cryotherapy probe (LCS 3000, Cryotech, UK) to temperatures ranging from −8 to −84°C. Results: (LoVo) Of 21 mice evaluable for analysis no tumors recurred in 3 mice which had their tumors frozen to less than −60°C as measured at the presumed tumor/host boundary, whereas all but one tumor recurred in 18 mice which had their tumors frozen to >−60°C. (C170) Of 18 mice evaluabl…
Cytokinfreisetzung nach hepatischer Kryotherapie in einem Rattenmodell
Die Kryotherapie hat in der Behandlung von primaren und sekundaren Lebertumoren in den letzten 10 Jahren zunehmend Bedeutung erlangt [3–5]. Die mit der Methode verbundene Mortalitat und Morbiditat ist gering [4]; Einzelfalle eines Syndroms von Multiorganversagen und Gerinnungsstorungen bis hin zur Verbrauchs-koagulopathie, ahnlich dem septischen Schock, jedoch ohne entzundlichen Fokus warden nach Kryotherapie beschrieben [4,8]. Dieser sogenannte Kryoschock [1] war fur den Tod von 2 Patienten nach grosvolumigen Einfriervorgangen an der Leber verantwortlich [8]. In einer weltweiten Umfrage unter Kryotherapiezentren wurde der Kryoschock bei 21 der 2173 erfasten Patienten (1%), vor allem nach g…