Cryosurgery for unresectable hepatic tumors

589

ABSTRACTS, 24th ANNUALMEETING TABLE 1-Abstract

117

PG (mgidl ? SEM) Group (n = 8 each)

Islets recovered/ transplanted

Freshly isolated Immediate cryo Culture 48 hr Culture cry0

2500 2375 2400 2325

Basal 104 4 105 -c 105 ? 103 -c

1

Diabetic 3 3 3 2

for

Unresectable

Hepatic

2

6

K value

10

95 t 542 -c 20 99 k 11 99 h 10 90 k 6 90 2 532 -c 43 166 -i- 27 144 f 30 101 2 5 86 2 7 77 2 6 87 r 537 2 16 99 f 8 534 5 27 190 k 38 155 + 30 120 2 16 100 r

-

covery or PG compared with immediately cryopreserved islets. We conclude that tissue culture is not essential to improve the survival of rat islets of Langerhans cryopreserved with these methods. 118. Cryosurgery

ivGTT

Weeks postimplant

Tumors.

GARY ONIK, CHARLES COBB, DANIEL DIAMOND, GLENN STEELE, BLAKE CADY, ROBERT KANE, BORIS RUBINSKY, AND BARBARA PORTERFIELD(Allegheny General Hospital, 320 East North Avenue, Pittsburgh, Pennsylvania 15212-9986; and University of California-Berkeley, Berkeley, California). Current studies indicate that surgical resection is the only treatment that offers the hope of long-term survival (5 years or greater) for patients with metastatic colon carcinoma to the liver. Unfortunately, the majority of patients are unresectable due to tumors in proximity to major vascular structures or involvement of multiple hepatic lobes. In this paper the authors will describe a new cryosurgical procedure guided by intraoperative ultrasound that allows destruction of previously unresectable tumors. The procedure consists of an intraoperative ultrasound exam that delineates

(%/mm) 8 5 4 5

1.44 0.63 1.86 0.5

the tumor’s relationship to vascular structures and the presence of any additional lesions that are not palpable. Using an ultrasonic guide, an echogenic needle with a guide wire attached is placed into the tumor. Over the wire a dilator and cannula are placed. After removing the dilator and wire, the cryoprobe is placed through the cannula into the tumor. The tumor is frozen using liquid nitrogen (- 196°C) with the extent of freezing documented by ultrasound. At this time seven patients with unresectable tumors to the liver from colon carcinoma have been treated. Four of the seven patients have no evidence of disease either biochemically (CEA levels) or radiographically, the longest follow-up, 13 months. In addition, two patients with endocrine-secreting tumors of the liver have been treated with control of the patients’ symptoms. No serious complications have occurred. Preliminary data indicate that cryosurgery for unresectable liver tumors is technically feasible and offers the hope of long-term survival.

ARTHUR W. ROWE,EDITOR New York Blood Center New York, New York 10021