Cryosurgery for hepatocellular carcinoma

Cryosurgery is an important modality for treatment of unresectable hepatocellular carcinoma (HCC). There are different forms of cryosurgery for HCC which are intraoperative cryoablation with or without excision, laparoscopic liver cryosurgery, and percutaneous liver cryoablation under guiding of ultrasonography or CT. As a local therapy, cryoablation carries certain advantages over other forms of treatment:it is able to destroy only the tumor tissue in liver while sparing more noninvolved tissues; because of the warming effect of flowing blood in the large blood vessels, tumors close to these vessel system can safely undergo cryoablation; liver cryoablation is more effective than surgical resection in treating multiple tumors in the liver. Cryosurgery with combination of transarterial chemoembolization (TACE), alcohol injection or 125iodine seed implantation has a complementary efficacy. Clinically, cryosurgery for HCC is performed according to the following principles:tumors in liver 5 cm,≤3 in number, may be performed intraoperative or percutaneous cryosurgery; tumor in liver 5 cm,should receive TACE, and then percutaneous cryosurgery; tumor in liver 5 cm with irregular margin, may be given intraoperative or percutaneous cryosurgery, and then alcohol injection or 125iodine seed implantation in the margin of tumor.