Reduction in Recurrence Risk for Involved or Inadequate Margins With Edge Cryotherapy After Liver Resection for Colorectal Metastases

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Abstract
UNTIL RECENTLY, liver resection was the only potentially curative treatment for patients with liver metastases from colorectal cancer (CRCLM).1-4 Unfortunately, only a small proportion of patients are eligible for curative surgical treatment when the diagnosis of CRCLM is established.5,6 The advent of several imaging-controlled ablative techniques now offers the potential of survival advantage to a small number of patients with unresectable disease.7-12 Several attempts have been undertaken to increase the number of patients in whom curative resection can be performed. Techniques such as neoadjuvant chemotherapy,13 portal vein embolization,14 and contralateral-lobe tumor destruction15 have contributed to extend the percentage of patients eligible for curative complex liver surgery. Cryotherapy is an established treatment tool in destroying tumor tissue.16,17 In patients with either impaired liver function or small-volume remnant liver, cryotherapy is preferred to further liver resection to maintain maximal normal liver tissue and reduce the risk of postoperative liver failure. Dwerryhouse et al18 previously reported on the use of edge cryotherapy, but those results lacked long-term follow-up.