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PubMed1997

Prostatic cryosurgery: use of MR imaging in evaluation of success and technical modifications.

PURPOSE: To evaluate the usefulness of contrast material-enhanced magnetic resonance (MR) imaging in objective assessment of prostatic cryosurgery and the role of MR imaging in the modification of prostatic cryosurgical technique. MATERIALS AND METHODS: Thirty-eight consecutive patients with localized (T1-3, N0, M0) prostatic adenocarcinoma treated with prostatic cryosurgery underwent MR imaging without contrast enhancement before cryosurgery and unenhanced and gadolinium-enhanced MR imaging within 1-3 weeks after cryosurgery. The first 20 patients also underwent MR imaging at 3 months after cryosurgery. MR imaging findings were correlated with those from transrectal ultrasound-directed prostatic staging biopsy. RESULTS: Cryonecrotic prostate was identified as avascular regions characterized by absolute signal void on contrast-enhanced images. With progressive modification of cryosurgical technique, complete cryoablation of the prostate was achieved in the latter nine of the 38 patients. When cryoablation was considered complete according to MR imaging criteria, findings invariably correlated with those at biopsy, with no residual prostate tissue or tumor. CONCLUSION: Gadolinium-enhanced MR imaging of the prostate after cryosurgery provides a highly accurate means of monitoring success. Objective MR imaging findings allow modifications to the technology and technique, resulting in optimal therapeutic results with prostatic cryosurgery.

Adenocarcinoma↗
PubMedDate not supplied

Image-guided prostate cryosurgery: state of the art.

BACKGROUND: Cryosurgery was first used to treat prostate cancer in the early 1970s but it was not until 1993, when the results from percutaneous ultrasound-guided cryosurgery were published, that the potential advantages of this treatment became apparent. Changes in equipment and techniques have improved the results of cryosurgery, in both tumor control and lower morbidity. METHODS: The author has reviewed data of his own and those of others concerning the changes in techniques employed and outcomes from prostate cryosurgery. RESULTS: Ultrasound-guided percutaneous transperineal placement of the cryoprobes allows monitoring of freezing in real time. Monitoring temperature at critical locations, separating the rectum and prostate by saline injection, and using argon gas rather than liquid nitrogen-based equipment have improved results and lowered complication rates. The technique produces outcomes similar to those obtained with brachytherapy and three-dimensional conformal radiation therapy. CONCLUSIONS: Advantages of cryosurgery include the ability to re-treat patients without added morbidity and to treat salvage postradiation patients with acceptable results and morbidity. The recent demonstration that "nerve-sparing" cryosurgery is possible suggests that cryosurgery may be used more often.

Cryosurgery↗
PubMed1998

[A role for cryosurgery in the treatment of non-resectable liver metastases of colorectal neoplasms].

Liver metastases occur in over 40% of patients with colorectal carcinomas. The best prospect of cure is achieved by resection of the metastases. However, only 10-15% of the patients with hepatic metastases are estimated to be candidates for resection. When curative resection cannot be performed the options for treatment are limited. Response rates to chemotherapy are around 40% and even then survival benefit is generally limited to a few months. Hepatic cryosurgery recently provided a new therapeutic approach for unresectable liver metastases. For cryosurgery tumour tissue is located by ultrasonography and then cooled by liquid nitrogen to a temperature of -196 degrees C, which results in necrosis of tumour tissue. In a limited number of series encouraging results of cryosurgery have been reported. One year and two year survival rates of respectively 70% and 50% were reported after cryosurgery for hepatic metastases. Disease free survival rate after 2 years varies from 20% to 28%. If recurrence of the disease occurred in the liver it was generally outside the areas treated by cryosurgery. Benefit in survival is only achieved when all tumour tissue is treated adequately. Hepatic cryosurgery is appropriate in those patients with unresectable metastatic disease in whom cryosurgery alone or in combination with resection is able to eradicate all metastatic disease in the liver.

Antineoplastic Agents↗
PubMedDate not supplied

Cryosurgery of tumor tissue causes endotoxin tolerance through an inflammatory response.

INTRODUCTION: Earlier reports on animal studies showed inhibition of secondary tumor growth and metastases after cryoablation, probably mediated by an inflammatory response. In this study enhancement of this inflammatory response and its possible additive antitumor effect is evaluated in a mouse tumor model. MATERIALS AND METHODS: Mice received two subcutaneously implanted C--26B tumors on, respectively, day 0 (thigh) and day 7 (flank). The thigh tumor was treated by either cryoablation or resection. In addition the animals received a single dose of lipopolysaccharide (LPS) or anti-IL10 together with, or two days after, surgical treatment. The growth of the flank tumor was followed and plasma levels of IL-1 alpha and TNF-alpha were measured. RESULTS: Compared to excision of the primary tumor, cryosurgery clearly induced inhibition of secondary tumor growth while plasma levels of TNF (0.09) and IL-1 (0.06) were significantly elevated after cryosurgery when compared to excision (TNF 0.0, IL-1 0.03; p < 0.01). Administration of LPS two days after cryosurgery did not lead to extra inhibition of secondary tumor growth, even at high doses. Remarkably, dose--response studies with LPS administered two days after treatment showed a high mortality at a dose of 200 micrograms (75%) in the excision group while mortality in the cryo-treated group was 13% (p < 0.02). Mortality was directly related to cytokine levels that were significantly higher in the excision group (TNF 3.60, IL-1 0.30) when compared to the cryo-treated group (TNF 1.0, IL-10.15; p < 0.01). In contrast, when 25 micrograms LPS was given at the same time as treatment of the primary tumor either by cryosurgery or excision, mortality in the cryo-treated group (85%) was higher than in the excision group (14%, p < 0.05). Again mortality was related to post-treatment cytokine levels which now were significantly higher in the cryo-treated animals (TNF 1.30, IL-10.35) than in animals treated by excision (TNF 0.60, IL-10.10; p < 0.01). Administration of anti IL-10 did not lead to extra tumor growth inhibition. CONCLUSION: These experiments confirm the hypothesis that cryosurgery leads to a systemic inflammatory response. This reaction can lead to the inhibition of tumor growth. Administration of LPS after cryosurgery does not lead to an extra anti-tumor response; animals appear to become endotoxin tolerant. Adversely, when LPS is administered together with cryosurgery, the animals are extremely sensitive to LPS. These findings are in accordance with the clinical observation of cryoshock after cryoablation of liver metastases.

Animals↗
PubMed1993

[An experimental study on the induction of anti-tumor immunological activity after cryosurgery for liver carcinoma, and the effect of concomitant immunotherapy with OK432].

Cryosurgery on liver carcinoma (MRMT-1) in rats and pre-operative administration of OK432 were performed in order to study host immunological response and the effect of immunotherapy before cryosurgery, respectively. Rats were divided into five groups, by treatment given: control, false-operative, incomplete-frozen, complete-frozen and complete-frozen + OK432-administrated groups under several conditions. In the incomplete-frozen group, the survival days significantly prolonged as compared with controls. Phytohemagglutinin (PHA) blast formation and CD4 positivity exhibited high levels at 8 weeks after cryosurgery. In the complete-frozen group, survival time was not prolonged and 3 cases of early death were observed. Moreover, CD4 positivity decreased at 3 days and CD8 positivity increased at 2 weeks after cryosurgery, significantly. On the other hand, in the complete-frozen + OK432-administrated group, CD4 positivity decreased gradually after cryosurgery. In contrast, PHA blast formation was significantly high at 8 weeks and the rise of CD8 positivity in the complete-frozen group was significantly suppressed with OK432 to a value of 31.8 +/- 4.1%. In addition, the survival time showed a prolonging tendency, with the exception of 2 cases of early death. From these results, we concluded that immunological response after cryosurgery for liver carcinoma may be induced by changes in cell immunity, and it was suggested that combination therapy with cryosurgery and preoperative immunotherapy might be effective.

Animals↗
PubMed1998

[High resolution ultrasound imaging: value in treatment of basocellular carcinoma by cryosurgery].

OBJECTIVE: We conducted a prospective evaluation of the contribution of high-resolution ultrasound imaging prior to cryosurgery for basocellular carcinoma and in search for recurrence. PATIENTS AND METHODS: All patients seen between 1992 and 1994 at the skin tumor clinic and treated by cryosurgery were included. Ultrasound imaging using 20 MHz prototype was performed prior to cryosurgery and 2 months later. RESULTS: Among 101 patients treated, 112 basocellular carcinomas were treated by cryosurgery. Ultrasound imaging provided good visualization of the tumor limits in all cases. The ultrasound aspect was anechogenic, often with rare areas of highly dense echoes. The tumor limits described by ultrasound imaging were larger than the clinical limits in 32% of the cases. In 8 of the 16 cases of recurrent tumors, the ultrasound examination revealed the recurrence first. In the other 8 cases, clinical manifestations were confirmed by ultrasonography. In our series, recurrence of basocellular carcinoma was statistically more frequent when the depth of the tumor was 3 mm (ultrasonographic measurement) or when the lateral limits established by ultrasound assessment were greater than the clinical evaluation. DISCUSSION: These findings demonstrate that high-resolution ultrasound imaging of basocellular carcinomas prior to cryosurgery: 1) visualizes tumor limits allowing adapted cryosurgery, 2) identifies factors with predictive value for recurrence, 3) can identify recurrences early. Ultrasound imaging of the skin is a useful non-invasive technique for pre- and post-therapeutic assessment of skin tumors and could be a particularly useful tool for "blind" cryosurgery destruction of skin tumors.

Adult↗
PubMedDate not supplied

Cryosurgery of liver cancer.

Cryosurgery, the in situ destruction of tissue using subzero temperatures, has been used to treat hepatic metastases. Because it is a focal treatment, cryosurgery can be used in patients with unresectable lesions due to location (next to major blood vessels) or multiplicity. In this study, 57 patients with unresectable hepatic metastases were treated with cryosurgery (with at least a 6-month follow-up). The number of lesions treated ranged from 1-16 with a mean of 4.6. Forty-three patients (73%) had bilobar disease, while 25 patients (42%) were treated with a combination of resection and cryosurgery. The disease-free survival rate (patients with normal computed tomography [CT] scans and carcinoembryonic antigen [CEA] levels) was 27% with a mean follow-up of 21 months. This is comparable to other hepatic cryosurgery studies that have found survival rates of 25-37.5%. Although the results are still short-term, this study indicates that hepatic cryosurgery offers the hope of long-term survival in patients with unresectable hepatic metastases.

Colonic Neoplasms↗
PubMed1988

Comparison of excision versus cryosurgery of an HSV-2-induced fibrosarcoma. I. Survival, extent of metastatic disease and host immunocompetence following surgery.

Cryosurgery and excision were used to treat primary tumours of HSV-2-transformed hamster tumour sublines, and post-operative survival and the extent of metastatic disease were compared in the two groups. An inferior prognosis was observed following cryosurgery although the extent of metastatic disease was similar in both groups. Using this model it would appear that cryosurgery enhances the development of micrometastases rather than affecting the number of cells shed from the primary tumour during surgery. To investigate the underlying causes of the decrease in survival following cryosurgery, in vitro assays were used to monitor host immunocompetence following surgery. The results showed that whilst natural killer cell cytotoxicity was only marginally depressed, mitogen responsiveness and lymphocyte participation in a mixed lymphocyte reaction were severely reduced 3-7 days post-cryosurgery. In parallel with immunosuppression, extensive cell proliferation in the spleen of cryosurgically treated tumour-bearing animals was observed. Histological examination of the spleen demonstrated the presence of large numbers of transformed cells which correlated with the loss of mitogen responsiveness and the ability to participate in a mixed lymphocyte reaction. Further studies (manuscript submitted for publication) have demonstrated that spleen cells from animals whose tumour is treated by cryosurgery are capable of suppressing immunocompetence in vitro, implying they have a role in the uncontrolled growth of micrometastases in vivo.

Animals↗
PubMed2002

A breakthrough in cryosurgery.

Liver cryosurgery is one of the treatment options for unresectable liver metastases. Indications for the use of this treatment instead of classic surgery are bilobar disease, location of the tumor at an irresectable anatomic site, and comorbid conditions of the patient. Possible complications of cryosurgery are hemorrhage, coagulopathy, pneumonia, pleural effusion, abdominal abscess, and bile fistula. We describe a patient in whom a hepatobronchial fistula developed after cryosurgery. The patient had cryosurgery because of an unresectable liver metastasis in a Dukes' C rectal carcinoma. More details are given in the case report. To our knowledge, a hepatobronchial fistula as a complication of cryosurgery has never been reported. It therefore should be added to the list of possible cryosurgery complications.

Antimetabolites, Antineoplastic↗
PubMed1986

Immunological response of regional lymph nodes after tumor cryosurgery: experimental study in rats.

Seven days after inoculation of metastasizing rat mammary tumor No. 1 into the thigh of 5-week-old female Sprague-Dawley rats, the tumor was treated cryosurgically by two-cycle freezing and by contact methods at -170 degrees C. Weights of the thymus and the spleen, histological findings of the lumbar lymph nodes, phytohemagglutinin (PHA)-induced blastogenesis of lymphocytes obtained from the lumbar lymph nodes and peripheral blood, and resistance rate to tumor rechallenge were examined 1, 3, 6, 10, and 17 week(s) after cryosurgery, with the following results: Thymus weight gradually decreased by 3 weeks after cryosurgery, while spleen weight increased by 1 week, recovering the preoperative level at 6 weeks. Paracortical hyperplasia of the lumbar lymph nodes markedly increased in 1 week and sinus histiocytosis increased after 3 weeks, both remaining at high values until 10 weeks, while germinal center hyperplasia showed a high value at 3 weeks and thereafter decreased gradually. PHA-induced blastogenesis of the lumbar lymph nodes significantly increased 1 week after cryosurgery and remained at its high value until 10 weeks. PHA-induced blastogenesis of peripheral lymphocytes showed the lowest value at 3 weeks and then significantly increased at 6 weeks. Resistance rate to rechallenge showed the lowest value at 3 weeks, reaching the highest level 10 weeks after cryosurgery. From the above results, it was suggested that anti-tumor immunity (resistance to tumor rechallenge) induced by cryosurgery was at the lowest level at 3 weeks after cryosurgery, and gradually increased starting at 6 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1989

Bone marrow embolism following cryosurgery of bone: an experimental study.

Cryosurgery is commonly used in medicine for treatment of benign and malignant lesions. We had clinical and experimental data indicating that cryosurgery of intact bone could cause bone marrow intravasation and embolism, i.e., particles of bone marrow entering extraosseous veins and occluding pulmonary vasculature. This study was designed to investigate the pathogenesis of bone marrow intravasation and embolism after cryosurgery. Three hypotheses on the pathogenesis of bone marrow intravasation were tested using a model of cryosurgical continuity lesion in rats and rabbits. Influence of physical and circulatory factors were excluded supporting a mechanical-biological hypothesis; the intravasation of bone marrow after cryosurgery of bone is caused by an increased intramedullary pressure. The increased intramedullary pressure is due to edema in the medullary cavity caused by cryosurgical damage to cell membranes. It is demonstrated that the bone marrow intravasates can embolize to the lungs causing respiratory insufficiency. This can be a serious complication following cryosurgery of intact bone. Prophylactic decompression of the medullary cavity can possibly prevent the rise in intramedullary pressure and thus intravasation and embolisation of bone marrow after cryosurgery of intact bone.

Animals↗
PubMed2003

Improved image contrast with mangafodipir trisodium (MnDPDP) during MR-guided percutaneous cryosurgery of the liver.

The present study was undertaken to measure the gain observed in the liver-to-tumor contrast of perioperative images when using mangafodipir trisodium, a liver-specific contrast agent, during percutaneous cryosurgery of the liver performed under the guidance of magnetic resonance images. Retrospective quantitative analyses of MR images were performed on eleven patients having a total of 30 liver tumors treated by MR-guided percutaneous cryosurgery. An initial group of four patients were treated with no contrast agent, and was compared with a second group of 7 patients who received an intravenous injection of 5 microM/kg of mangafodipir for their cryosurgery. The percutaneous cryosurgery was monitored under the near-real-time-imaging mode of a 0.5T open-configuration MRI system using a T(1)-weighted Gradient-recalled echo pulse sequence. A significant improvement in the liver-to-tumor contrast-to-noise ratio was observed with mangafodipir (p < 0.05, paired t test) in 0.5T preoperative images. Along with the stability of the mangafodipir contrast enhancement during the entire cryosurgical procedure, the resulting gain in contrast allowed for better visualizing the presence of residual untreated tumor margins at the periphery of the cryosurgery iceball directly from perioperative images acquired with patients under narcosis. Consequently, it not only became easier for the interventionalist to determine the need for an additional cryoprobe to increase the size of the iceball during the procedure, but also to decide on the appropriate end point of the cryosurgery.

Adult↗
PubMed2003

Cryoheater as a means of cryosurgery control.

A new concept for cryosurgery control is presented in this paper, a concept which has the potential to dramatically change the outcome of cryosurgery. Unlike other cryosurgery control techniques, which are based on controlling the thermal performance of the cryoprobe, this new concept is based on heating the treated tissue as a means of shaping the frozen region. The new controlling heater is termed a 'cryoheater'. The cryoheater is a complementary device to the cryoprobe and can work with any cryosurgery cooling technique. In the current pilot study, the new cryoheater is demonstrated in a gelatin solution and, using heat transfer simulations, it is studied in simulated cases of prostate cryosurgery. It is suggested that cryosurgery planning tools and optimization techniques must be developed before the concept of the cryoheater can be applied in its full capacity.

Body Temperature↗
PubMed2003

Treatment of organ confined prostate cancer with third generation cryosurgery: preliminary multicenter experience.

PURPOSE: Cryosurgical ablation of the prostate is 1 approach to the treatment of localized prostate cancer. Third generation cryosurgery uses gas driven probes that allow for a decrease in probe diameter to 17 gauge (1.5 mm). The safety, morbidity and preliminary prostate specific antigen (PSA) results of 122 cases are reported. MATERIALS AND METHODS: A total of 106 patients have undergone percutaneous cryosurgery using a brachytherapy template with at least 12 months of PSA followup. Immediate and delayed morbidities were evaluated. PSA results at 3 and 12 months were recorded, and failure was defined as the inability to reach a nadir of 0.4 ng/ml or less. RESULTS: Complications in patients undergoing primary cryosurgery included tissue sloughing (5%), incontinence (pads, 3%), urge incontinence/no pads (5%), transient urinary retention (3.3%) and rectal discomfort (2.6%). There were no cases of fistulas or infections. Postoperative impotence was 87% in previously potent patients. For patients who underwent salvage cryosurgery there were no fistulas reported and 2 (11%) patients required pads after salvage cryosurgery. A total of 96 (81%) patients achieved a PSA nadir of 0.4 ng/ml or less at 3 months of followup, while 79 of 106 (75%) remained free from biochemical recurrence at 12 months. A total of 42 (78%) low risk patients (Gleason score 7 or less and PSA 10 or less) remained with a PSA of 0.4 ng/ml or less at 12 months of followup, compared to 37 (71%) high risk patients. All patients were discharged within 24 hours. CONCLUSIONS: After a followup of 1 year 3rd generation cryosurgery appears to be well tolerated and minimally invasive. The use of ultrathin needles through a brachytherapy template allows for a simple percutaneous procedure and a relatively short learning curve. A prospective multicenter trial is ongoing to determine the long-term efficacy of this technique.

Aged↗
PubMed2001

Cryosurgery of normal and tumor tissue in the dorsal skin flap chamber: Part II--injury response.

It has been hypothesized that vascular injury may be an important mechanism of cryosurgical destruction in addition to direct cellular destruction. In this study we report correlation of tissue and vascular injury after cryosurgery to the temperature history during cryosurgery in an in vivo microvascular preparation. The dorsal skin flap chamber implanted in the Copenhagen rat, was chosen as the cryosurgical model. Cryosurgery was performed in the chamber on either normal skin or tumor tissue propagated from an AT-1 Dunning rat prostate tumor, as described in a companion paper (Hoffmann and Bischof, 2001). The vasculature was then viewed at 3 and 7 days after cryoinjury under brightfield and FITC-labeled dextran contrast enhancement to assess the vascular injury. The results showed that there was complete destruction of the vasculature in the center of the lesion and a gradual return to normal patency moving radially outward. Histologic examination showed a band of inflammation near the edge of a large necrotic region at both 3 and 7 days after cryosurgery. The area of vascular injury observed with FITC-labeled dextran quantitatively corresponded to the area of necrosis observed in histologic section, and the size of the lesion for tumor and normal tissue was similar at 3 days post cryosurgery. At 7 days after cryosurgery, the lesion was smaller for both tissues, with the normal tissue lesion being much smaller than the tumor tissue lesion. A comparison of experimental injury data to the thermal model validated in a companion paper (Hoffmann and Bischof 2001) suggested that the minimum temperature required for causing necrosis was -15.6 +/- 4.3 degrees C in tumor tissue and -19.0 +/- 4.4 degrees C in normal tissue. The other thermal parameters manifested at the edge of the lesion included a cooling rate of approximately 28 degrees C/min, 0 hold time, and a approximately 9 degrees C/min thawing rate. The conditions at the edge of the lesion are much less severe than the thermal conditions required for direct cellular destruction of AT-1 cells and tissues in vitro. These results are consistent with the hypothesis that vascular-mediated injury is responsible for the majority of injury at the edge of the frozen region in microvascular perfused tissue.

Animals↗
PubMed2006

Two-phase computerized planning of cryosurgery using bubble-packing and force-field analogy.

BACKGROUND: Cryosurgery is the destruction of undesired tissues by freezing, as in prostate cryosurgery, for example. Minimally invasive cryosurgery is currently performed by means of an array of cryoprobes, each in the shape of a long hypodermic needle. The optimal arrangement of the cryoprobes, which is known to have a dramatic effect on the quality of the cryoprocedure, remains an art held by the cryosurgeon, based on the cryosurgeon's experience and "rules of thumb." An automated computerized technique for cryosurgery planning is the subject matter of the current paper, in an effort to improve the quality of cryosurgery. METHOD OF APPROACH: A two-phase optimization method is proposed for this purpose, based on two previous and independent developments by this research team. Phase I is based on a bubble-packing method, previously used as an efficient method for finite element meshing. Phase II is based on a force-field analogy method, which has proven to be robust at the expense of a typically long runtime. RESULTS: As a proof-of-concept, results are demonstrated on a two-dimensional case of a prostate cross section. The major contribution of this study is to affirm that in many instances cryosurgery planning can be performed without extremely expensive simulations of bioheat transfer, achieved in Phase I. CONCLUSIONS: This new method of planning has proven to reduce planning runtime from hours to minutes, making automated planning practical in a clinical time frame.

Computer Simulation↗
PubMed2004

Cryosurgery for lung cancer: clinical results and technical aspects.

Lung carcinoma is the most frequently diagnosed malignancy in the world, with the incidence increasing through the 20th century. Presentation may be as a tumor mass primarily obstructing the central bronchial lumen, or a mass infiltrating lung tissue. Cryosurgery can be used as a method of palliative treatment for both these endobronchial and extrabronchial presentations. The aim of this study is two-fold: to present data relating to our extensive experience in treating obstructing endobronchial tumors and to present our initial results of direct cryosurgery to infiltrating lung tumor masses. During a nine-year period, 521 consecutive patients (male:female ratio 1.8:1) with a mean age of 67.9 years who had advanced obstructive tracheobronchial malignant tumors underwent cryosurgery with a mean of 2.4 treatments per patient. Hemoptysis, cough, dyspnoea and chest pain improved by at least one class in 76.4%, 69.0%, 59.25% and 42.6% (p<0.01) of symptomatic patients respectively. Quality of life studies showed that the mean Karnofsky score improved from 60 +/- 7 to 75 +/- 8 and the mean WHO score from 3.04 +/- 0.7 to 2.20 +/- 0.56. There were 7 (1.2%) in-hospital deaths, and 2-year survival was 15.9%. Direct cryosurgery to carcinoma of the lung was performed on 15 patients at exploratory thoracotomy. Results showed an increase in FEV1 from 1.80 +/- 0.6 liters to 1.95 +/- 0.8 (8.3%) liters and in FVC from 2.50 +/- 0.8 to 2.68 +/- 0.8 liters (7.2%). The Karnofsky score improved from 68 +/- 9 to 78 +/- 10 and the WHO score from 2.63 +/- 0.81 to 2.38 +/- 0.78 (9.6%). Major symptoms including cough, dyspnoea, and hemoptysis were assessed and showed improvement in 77.8%, 66.7%, and 100% (p<0.01) of symptomatic patients respectively. Patients were followed for a mean period of 18 months (range 4-84 months). Median survival from the date of surgery (Kaplan-Meier, 95%Cl) was 11.6 (6.8 to 18.2) months, range 1 to 84 months. Cryosurgery provides a safe and effective method for the palliation of advanced central bronchial obstructive tumors, and compares favorably with other methods in terms of safety, cost, and complications. Initial experience suggests that similar palliation may be achieved by cryosurgery applied to advanced parenchymal tumor masses.

Adult↗
PubMed1977

Cryosurgery of bronchopulmonary structures. An approach to lesions inaccessible to the rigid bronchoscope.

Cryonecrosis of the upper lobe of the lung and bronchi was safely inudced in healthy dogs by application of the cryoprobe to serosal surfaces or, through a bronchotomy, to the mucosal surfaces under direct vision. Seven days after cryosurgery, hyperemia of the bronchus was seen. By 14 days the bronchus at the target site was covered with cuboidal epithelium. Reappearance of normal ciliated epithelium occurred by 180 days after cryosurgery. Cartilage remained intact, and there was no evidence of formation of a stricture or other gross alteration of bronchial architecture. In the lung there was coagulation necrosis; and by 14 days after cryosurgery, there was fibrosis in the target area. There were no complications of the pleural space. Cryosurgery of tissues at the margins of the bronchotomy does not impair healing. Cryosurgery may reduce the necessity for extensive surgery in selected patients with bronchopulmonary tumors, including those inaccessible to the rigid bronchoscope. Clinically, eight patients with recurrent bronchogenic tumors have received palliation by transbronchoscopic cryosurgery.

Animals↗