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PubMed2003

Early results of a modified technique of cryosurgery.

The objective of this study was to present a simple, convenient, and reliable technique for the application of liquid nitrogen and to evaluate the effectiveness of curettage and cryosurgery. Between 1992 and 2002, 24 patients who had benign aggressive and low-grade malignant bone tumors were treated by curettage and cryosurgery. While cryosurgery was applied by the "direct pour" technique in the first seven patients, it was applied by the "pressurized spraying" technique in the others. Functional results were graded according to Enneking. The mean follow-up was 47 (range 9-131) months. There were no local recurrences. Three patients who underwent the direct pour technique developed partial skin necrosis. The functional results were excellent in 14 patients, good in six, and fair in four. When compared with previous reports on cryosurgery and its application techniques, we detected no tumor recurrence or complications, including soft-tissue injury, infection, and late fracture with liquid nitrogen applied by the pressurized spraying technique.

Adolescent↗
PubMed1985

An investigation on the use of cryosurgery for treatment of bone spavin, splint, and fractured splint bone injuries in standardbred horses.

Bone spavin, splint, and fractured splint bone injuries have been treated with varying methodologies at Wheatley Hall Farm Equine Clinic. Cryosurgery is the most successful. With cryosurgery the small, pain-producing afferent C fibers are destroyed, and painful neuromas do not return. Injured sites were cryosurgically treated with liquid nitrogen for a double freeze-thaw period of 45 sec. 5 sec, 45 sec. Before and after treatment comparisons were conducted on study standardbreds. In all three injury groups, results showed that the standardbreds tended to race as well or with improved times and classes after treatment. With cryosurgery, the horse undergoes a relatively short layoff period and does not experience any of the problems associated with other surgical procedures. Unlike denerving, a horse is still aware of outside stimulus to the treated area. Based upon personal observation and this preliminary investigation, cryosurgery provides a successful treatment alternative which is safe and humane to the horse, requiring a very short layoff or recovery time.

Animals↗
PubMed1982

Cryosurgery in prostatic cancer: survival.

From 1969 through 1976 we performed cryosurgery in 229 cases of prostatic cancer. This article presents survival in cryosurgery and other treatment groups. In every stage, despite a preponderance of large primary tumors and poor-risk patients, cryosurgery matched total prostatectomy and compared favorably to other modalities, including radiation therapy, at our center and elsewhere. According to previous authors, and in view of the present data, eradication of the local lesion is associated with better survival even in advanced cases. Cryosurgery provides a safe, effective method.

Aged↗
PubMed1983

Cryosurgery in prostatic cancer: elimination of local lesion.

From 1969 through 1976, we performed cryosurgery in 229 cases of prostatic cancer. Most of these patients had bulky, locally extensive primary tumors, and one-half had disseminated disease. Through the open perineal approach, which gives exposure for an adequate freeze, cryosurgery has been well tolerated. The primary surgical goal has been to reduce or eliminate the local lesion to minimize subsequent cancer-related lower urinary tract problems and to cure those patients with truly localized disease. In every case cryosurgery produced dramatic shrinkage of the local lesion. After four to eight weeks a local recurrence was suspected in 13 per cent, and 41 per cent eventually had some evidence of a recurrent cancer nodule or persistent cancer in the bladder neck. In a series of statistical analyses we have related these recurrences to other clinical factors. Cryosurgery has been a safe, effective way to reduce or eliminate the primary prostatic cancer, even in patients with large local lesions.

Aged↗
PubMed1992

Reactive lentiginous hyperpigmentation after cryosurgery for lentigo maligna.

BACKGROUND: Twenty patients treated for lentigo maligna of the face with cryosurgery developed benign lentiginous hyperpigmentation mimicking a recurrence. OBJECTIVE: When cryosurgery is used in the treatment of lentigo maligna, it is important to know whether repigmentation of the scar represents true recurrence or a benign process. METHODS: Twenty patients were treated with cryosurgery for lentigo maligna of the face. Within a follow-up period of 7 to 80 months, frequent clinical observations were made. RESULTS: Lentiginous hyperpigmentation developed within the treatment area in eight patients. Histologic investigation revealed recurrence of lentigo maligna in three and benign hyperpigmentation in five. CONCLUSION: Genetic factors and UV exposure after cryosurgery may favor the development of benign lentiginous hyperpigmentation. Because recurrence of lentigo maligna must be considered, histologic evaluation of repigmentation is mandatory.

Aged↗
PubMed1991

Cryosurgery in 50 cases of tongue carcinoma.

From March 1975 to October 1985, 50 patients with primary tongue carcinoma were treated by cryosurgery. Forty-seven had squamous cell carcinoma, and 3 had other types of malignant tumors. The TNM clinical classification showed 12 patients with T1 lesions, 35 with T2, and 3 with T3. All patients were treated by cryosurgery in the outpatient clinic under local anesthesia. Three weeks after the primary tumors were controlled cryosurgically, 48 patients underwent radical neck dissections. All patients were observed for 3 to 10 years. After cryosurgery, the primary lesion disappeared in 45 (90%) patients; 5 were not controlled. The 3- and 5-year survival rates were 71.9% (23/32) and 72.3% (13/18), respectively. The recurrence rate in this series was 10% (5/50). Cryosurgery for tongue carcinoma was shown to be effective and safe.

Adult↗
PubMed1990

Epicardial cryosurgery as used in ablation of accessory atrioventricular pathways: effect on valvular function in the dog.

Epicardial cryosurgery for ablation of atrioventricular accessory pathways has surgical advantages. However, it is applied directly to the valve base. To assess the risk of valve impairment, 10 anaesthetized dogs were subjected to standardized epicardial cryosurgery of the right atrioventricular junction. Two of these underwent sham procedure (dissection only). Valve function was assessed by colour Doppler echocardiography preoperatively and at 2 days, 1 week, 2 weeks and 10 weeks postoperatively. Three out of the eight animals subjected to cryosurgery developed moderate (grade 2/4) tricuspid insufficiency, which appeared at 1 week postoperatively, following regression of congestive oedema. Two out of the three cases of TI were associated with leaflet prolapse. No tricuspid insufficiency was seen in the sham-operated animals. At the end of each interval two animals were killed for histological examination. Histological examinations showed that cryolesions extended a maximum of 3 mm into the valve leaflet. The tricuspid insufficiency is attributed to the extensive scarring (including chondroid metaplasia), which causes retraction and restricted motion of the annulus. It is concluded that cryolesions may impair atrioventricular valve function. Patients undergoing cryosurgery should be monitored postoperatively by echocardiography for atrioventricular valve insufficiency.

Animals↗
PubMed1978

Biopsy and clinical course after cryosurgery for prostatic cancer.

Open perineal cryosurgical prostatectomy has been reported previously in 154 consecutive prostatic cancer patients at our center. In 37 of these patients post-cryosurgery biopsies of the prostate were obtained. In the present report we compare this tissue to the preoperative biopsies. The data suggest that well differentiated cancers are associated with advantageous survival in cryosurgery patients. Lymphoid and eosinophilic cell infiltrates may represent post-cryosurgical local immune responses, with improved survival. Estrogen therapy seems to suppress this local immune response. One month or more after cryosurgery cancer in the biopsy correlates with palpable local recurrence but prior to 1 month it does not correlate. Cryosurgery by the open perineal approach has been an effective method to eliminate the primary lesion in localized and extensive prostatic cancer.

Biopsy↗
PubMed2002

Quality of life and sexuality of men with prostate cancer 3 years after cryosurgery.

The current study was designed to describe the long-term life quality and sexuality of men enrolled in a phase 2 clinical trial of cryosurgery for the treatment of localized prostate cancer. A total of 75 men were administered the Functional Assessment of Cancer Treatment-Prostate (FACT-P) before treatment and after treatment at 6 weeks, and at 3, 6, 12, 24, and 36 months. Additionally, these men completed a Sexuality Follow-Up Questionnaire (SFQ) 3 years after cryosurgery. By 12 months after cryosurgery, most FACT-P subscales had returned to pretreatment levels. Quality of life remained stable over the subsequent 2 years. The only exception to this general trend was persistent impairment in measures of social/family well-being. At 36 months, 13% (5 of 38) of patients had regained erectile functioning, and an additional 34% (13 of 38) of patients were sexually active with the help of aids. The 3-year quality-of-life outcomes support the renewed interest in cryosurgery. No late complications were observed. Whereas improvements in erectile function were observed between years 1 and 3 for some patients, most continue to experience erectile dysfunction. For these patients, aids are an important adjunct to the treatment of their erectile dysfunction.

Adenocarcinoma↗
PubMed2002

The evolution and state of modern technology for prostate cryosurgery.

Cryosurgery is the in situ ablation of a target tissue by application of extreme cold temperature. The ability of cryosurgery to ablate tissue is unquestioned. It is the controlled application of a cryoinjury in a manner to minimize morbidity that is problematic. Prostate cryosurgery is complicated by the proximity of the prostate to adjacent structures that are sensitive to a freeze injury, namely the urethra, rectal wall, and neurovascular bundles. Several recent technological advances have led to the development of an effective treatment protocol with acceptable morbidity. These include the advent of real-time transrectal ultrasound, cryomachines with almost instant freeze-thaw control through the use of the Joule-Thompson effect, and warming catheters to effectively preserve the integrity of the urethra and external sphincter. Further, temperature monitoring at the posterior margin of the prostate sometimes combined with an injection of saline solution into Denonvilliers fascia has reduced the occurrence of urethrorectal fistula formation to 0% to 0.5% in modern series. We review the key innovations of prostate cryosurgery that differentiate this state-of-the-art procedure from that used by early investigators to even that of the early 1990s. Potential future innovations, specifically related to image guidance of the procedure, are also addressed.

Body Temperature↗
PubMed1994

Cryosurgery for lentigo maligna.

BACKGROUND: The need for treatment of lentigo maligna is related to the cosmetic benefits and to the potential for malignant change. The usual treatment is excision, but often lesional size or location preclude this. OBJECTIVE: Our purpose was to show that cryosurgery is an effective alternative treatment modality for lentigo maligna. METHODS: Thirty white patients were treated with cryosurgery. The lesions ranged from 1.3 to 4.5 cm in diameter. Treatment consisted of freezing with liquid nitrogen delivered by open spray. RESULTS: The lesion recurred in two patients, yielding a recurrence rate of 6.6% during the average follow-up period of 3 years. The two recurrent lesions were successfully re-treated with cryosurgery. Eleven patients observed for more than 5 years showed no recurrence. CONCLUSION: Cryosurgery provides excellent cosmetic and curative results. These results are favorably comparable to excisional surgery.

Adolescent↗
PubMed1997

Temperature determination in the frozen region during cryosurgery of rabbit liver using MR image analysis.

Cryosurgery currently is being used clinically to treat tumors in internal organs such as the liver and prostate. Although performed at present under ultrasound monitoring, magnetic resonance imaging (MRI)-guidance of these procedures not only permits monitoring of the frozen region during cryosurgery but also makes it possible to determine the temperature distribution in the frozen region, which is not possible using ultrasound monitoring. A good estimate of the region of destruction in the tissue can be obtained from correlating the temperature distribution and the time course of the freezing with the image of the frozen region. Unfortunately, MR pulse sequence-based temperature determination techniques such as diffusion, relaxation time, and chemical shift cannot be used for measuring the temperature in the frozen region because the T2 of the frozen regions is so short that there is effectively no RF signal from the frozen region. This paper describes a numerical technique for determining the two dimensional temperature distribution in the frozen region during MR image-guided cryosurgery of normal liver in rabbits. The technique involves solving the energy equation numerically in the frozen region to determine the temperature distribution there. The boundary conditions needed to solve the equation are determined from MR images of the frozen tissue during cryosurgery and from the measured temperature of the cryoprobe. The calculated temperature in the frozen region is then correlated with the damaged region (cryolesion) determined from post mortem histologic evaluation.

Animals↗
PubMedDate not supplied

Cryosurgery after chemoembolization for hepatocellular carcinoma in patients with cirrhosis.

Most cirrhotic patients with hepatocellular carcinoma (HCC) are not candidates for resection. Transarterial chemoembolization (TACE) may ablate a significant portion of the tumor but has a high rate of recurrence. Cryosurgery may permit successful ablation of hepatic tumors but can be complicated by postoperative hemorrhage and is also associated with a significant risk of recurrence. The combination of the two techniques might be beneficial. We evaluated in a prospective study the safety and efficacy of this combination in cirrhotic patients with unresectable HCC. Fifteen patients were included in this study. All but one patient underwent one or several sessions of TACE before cryosurgery. Cryoablation was successfully performed in each patient. The patient who did not undergo preoperative TACE required reoperation for hemorrhage. Another patient with Child-Pugh class B cirrhosis died postoperatively of hepatic and multiorgan failure. At a mean follow-up of 2.5 years, three patients had recurrence of disease, and 13 of 15 patients were alive with the longest survival time being 5 years. The actuarial survival rate at 5 years was 79%. Cryosurgery after TACE is feasible in cirrhotic livers with HCC and can increase the cure rate in large tumors. TACE may reduce the risk of hemorrhage after cryosurgery but can increase the risk of hepatic failure in patients with poor hepatic function.

Adult↗
PubMed2003

Excision and cryosurgery in the treatment of conjunctival malignant epithelial tumours.

PURPOSE: To evaluate the long-term results of combined treatment with excision and cryosurgery for malignant epithelial tumours of the conjunctiva. METHODS: We retrospectively reviewed the medical records of patients diagnosed with conjunctival malignant epithelial tumours and treated with excision and cryosurgery between 1980 and 1998. The demographic features of the patients, characteristics of the tumours, and the peculiarities of the recurrences were recorded. The SPSS V 9.05 computed program was used for the statistical analysis of the results. Kaplan-Meier plots were used to determine the recurrence-free survival, and the logrank test was used to compare the recurrences according to histological classification. RESULTS: A total of 55 subjects (57 eyes), 19 female and 36 male, were included in the study. Their ages ranged between 15 and 82 years (mean 55+/-14 years). Histological diagnosis was conjunctival intraepithelial neoplasia (CIN) in 26 (46%) and invasive squamous cell carcinoma (SCC) of the conjunctiva in 31 eyes (54%). All eyes were treated with excision and cryosurgery with nitrous oxide probe. During the follow-up period of 6 months to 15 years, seven (12.3%) recurrences were observed. The success rate for patients with CIN and invasive SCC was 88.5 and 87.1%, respectively. There was no difference for recurrence rates between CIN and invasive SCC groups according to logrank test (P=0.68). CONCLUSIONS: Over the long-term follow-up, cryosurgery following excision is a successful method in the treatment of conjunctival intraepithelial tumours and invasive squamous cell carcinoma of conjunctiva with favourable outcome and minimal complications.

Adolescent↗
PubMed2001

Long-term results of treating hepatic colorectal metastases with cryosurgery.

BACKGROUND: The purpose of this study was to determine the long-term efficacy of cryosurgery as an adjunct to hepatic resection in patients with colorectal liver metastases not amenable to resection alone. METHODS: Thirty patients met the following inclusion criteria: metastases confined to the liver and judged irresectable, ten or fewer metastases, cryosurgery alone or in combination with hepatic resection allowed tumour clearance. RESULTS: Median follow-up was 26 (range 9--73) months. Overall 1- and 2-year survival rates were 76 and 61 per cent respectively. Median survival was 32 months. Disease-free survival at 1 year was 35 per cent, at 2 years 7 per cent. Six patients developed recurrence at the site of cryosurgery; given that the total number of cryosurgery-treated lesions was 69 the local recurrence rate was 9 per cent. CONCLUSION: In patients with colorectal liver metastases, local ablative techniques can be used as an effective adjunct to hepatic resection to obtain tumour clearance.

Aged↗
PubMed2000

Cryosurgery in difficult to treat basal cell carcinoma.

BACKGROUND: Basal cell carcinoma (BCC) is the most common human malignancy. Although BCC has a low mortality, it has a large morbidity. Patients frequently present with difficult to treat BCC because of the lesion itself, the condition of the patient, or both. Satisfactory results have been reported in the cryosurgery of low-risk BCC. There is no agreement, however, about indication, cure rate, technical modalities, and results of cryosurgery in tumors larger than 1 cm, in critical locations, and of aggressive histologic type. OBJECTIVE: The purpose of the study was to establish the cure rate, functional preservation, cosmetic results, acceptance, and complications of cryosurgery in difficult to treat BCC. METHODS: One hundred and thirty six consecutive patients with 171 difficult to treat BCC (because of size, location, nature, or patient condition) were treated by the mixed technique of curettage followed by liquid nitrogen application. RESULTS: After an average follow-up of 5.2 years (6 months to 9.1 years), a cure rate of 91.8% was achieved. The treatment was well tolerated, widely accepted by the patients, of low cost, and with good functional and cosmetic results. Complications were few and minor. CONCLUSION: Cryosurgery is a well-tolerated therapeutic modality that offers an acceptable cure rate and good functional and cosmetic results in difficult to treat BCC.

Adolescent↗
PubMed2003

Treatment of chromomycosis by cryosurgery with liquid nitrogen: 15 years' experience.

BACKGROUND: Chromomycosis is a chronic fungal infection of the skin and subcutaneous tissue caused by various dematiaceous fungi, the most common of which is Fonsecaea pedrosoi. The disease is difficult to treat. METHODS: Twenty-two chromomycosis patients treated by cryosurgery with liquid nitrogen as the sole or associated therapy were studied. Diagnosis was confirmed by direct examination of KOH cleared specimens, culture, and histology, according to a method previously described by Pimentel et al. (Pimentel ERA, Castro LGM, Cucé LC, Sampaio SAP. Treatment of chromomycosis by cryosurgery with liquid nitrogen. J Dermatol Surg Oncol 1989; 15: 72-77). Small lesions were frozen in a single session, whilst larger lesions were frozen in small parts. All patients received double freeze-thaw cycles. An author-created severity index, based on the extent of the diseased area, number of lesions, presence of complications (lymphedema, ulceration, and secondary infection) and unresponsiveness to previous treatments, was used to determine disease severity. RESULTS: Fonsecaea pedrosoi was isolated from all but one patient. Caucasian (50.0%) males (4.5 : 1.0) were most commonly affected. The average number of cryosurgery sessions per patient was 6.7, varying from one to 22 sessions. The duration of treatment lasted for up to 126 months. Nine patients (40.9%) were considered to be cured (clinically disease-free period of at least 3 years), eight (36.4%) were under observation (clinically disease-free but less than 3 years of follow-up), two (9.1%) were under treatment (still with active lesions), and three (13.6%) were classified as unsuccessful. The average cure period was 7.5 years, varying from 3 to 16 years. Five (55.6%) of the nine cured patients had been cured for periods exceeding 9 years. Six (66.7%) of the nine cured patients were classified as having mild, two (22.2%) severe, and one (11.1%) moderate disease. CONCLUSIONS: Cryosurgery with liquid nitrogen is an option in the treatment of chromomycosis.

Chromoblastomycosis↗
PubMed2000

Cosmetic results of cryosurgery versus surgical excision for primary uncomplicated basal cell carcinomas of the head and neck.

BACKGROUND: The incidence of multiple facial basal cell carcinomas (BCCs) is increasing. OBJECTIVE: Comparison of cosmetic results after cryosurgery and excision for primary BCCs. METHODS: Cosmetic results after cryosurgery and excision (prospective randomized study) of primary BCCs in the head/neck area were assessed by five independent professional observers and by the patients. RESULTS: Ninety-six BCCs were treated either with surgical excision (n = 48) or cryosurgery (n = 48). Clinical professionals evaluated the cosmetic results after surgery as significantly better. The beautician had no preference for either therapy. The patient had a significant preference for excision. Localization and size of the tumor did not modify this general preference for excision. The male dermatologist, however, had a tendency to evaluate results in the cheek, periauricular, and neck area as inferior to those in the rest of the face, regardless of which therapy was given. CONCLUSION: In general, cosmetic results after excision are better than after cryosurgery.

Adolescent↗