1. Cryosurgical Treatment of Tumors of the Liver and Pancreas Patyutko Y.I., Podluzhny D.V., Gakhramanov A.D. Russian Cancer Research Center, Moscow, 2013

2. Cryosurgical Treatment for Tumors of the Liver and Pancreas of 64 patients received Cryosurgical Treatment for Tumors of the Liver and Pancreas of 64 patients received

3. Cryosurgical device «CRYO-МТ»

4. Cryotherapy technique Cryosurgery is a direct application of extreme cold on the front surface of the tumor. The temperature was determined in the range from -180°C to -190°C, during a single procaedure exposure ranged from 7 to 25 minutes, diameter cryoapplicator varied from 20 to 50 mm Cryotherapy was performed in one, two or three positions. In some patients, cryotherapy was performed in two cycles with complete thawing and recryodestruction in the same place. Applicator was used to perforation and for destruction of tumors located deep in the organ parenchyma.

5. Dining cryosurgery 1. Cryosurgery tumor as an independent method of treatment. Apply with unresectable tumors of the pancreas and liver 2. Cryosurgery plus radical surgery. 3. Cryosurgery plus radiotherapy. 4. Cryosurgery plus chemotherapy. Cryodestruction supplemented standard chemotherapy schemes. 5. Cryosurgery in place of the removed tumor. It is performed as a non- radical surgery to reduce the possibility of the local recurrence. 6. Cryosurgery before mobilization pancreas. It is used to eliminate the dissemination of the tumor after mechanic damaged during mobilization. Then a radical operation is performed.

6. Cryosurgery as an independent method of treatment. It was used in case of non-resectable liver tumors, and pancreas. It was used in case of non-resectable liver tumors, and pancreas. This method was performed in 24 patients with the pancreatic tumors and in 4 patients with liver tumors This method was performed in 24 patients with the pancreatic tumors and in 4 patients with liver tumors

9. Analgesic effect of different treatment methods unresectable pancreatic tumors number of patients with analgesic effect Cryo-surgery + radiotherapy Cryo-surgery + chemotherapy Incomplete analgesia 50%18,2%30% Complete analgesia 50%72,8%70%

10. Survival of patients with ductal pancreatic adenocarcinoma undergoing various treatment options. method of treatmentlocalizationmedian1 year2 year Distal pancreatectomy n = 23 distal7,5 мес.9%0% Cryosurgery n=24 distal5,8 мес.5,17%0% Cryosurgery + radiotherapy n=10 distal6,7 мес.0% Cryosurgery + chemotherapy n=12 distal9,0 мес.22,2%18,2% Radiotherapy n=3 distal4,6 мес.0% Radiotherapy n=21 head8 мес.19% 4,7% Symptomatic treatment n=11 Аll3,9 мес.0%

11. Cryosurgery plus operation When bilobar tumor liver disease liver resection is performed on the side of larger lesions and cryotherapy tumor nodules in the remaining lobe of the liver. When bilobar tumor liver disease liver resection is performed on the side of larger lesions and cryotherapy tumor nodules in the remaining lobe of the liver. Or resection of the pancreas and liver metastases cryosurgery. Performed in 23 patients.

14. Cryosurgery before mobilization of the pancreas. Performed to avoid dissemination of the tumor after mechanic damage during mobilization. Then, the radical operation. Performed to avoid dissemination of the tumor after mechanic damage during mobilization. Then, the radical operation. Cryo + Distal pancreatectomy 2 patients Cryo + pancreatoduodenal ectomy 2 patients

16. Cryotherapy in place of the removed tumor. Performed with non-radical surgery to reduce the possibility of the pancreatic tumors Performed with non-radical surgery to reduce the possibility of the pancreatic tumors local recurrence local recurrence Distal pancreatectomy + cryo 8 patients Pancreatoduodenalectomy + cryo 4 patients Hepatectomy + cryo 3 patients

18. Mortality rate 4.9% Causes of deaths: - Acute renal failure, - Acute cardiovascular failure, - Bleeding from acute gastric ulcers.

19. Cryodestruction of the liver tumors and the pancreatic tumors is a safe and effective procedure. The advantages of this method are biological inertness of cryonecrosis hearth and easy technique. Cryodestruction of the liver tumors and the pancreatic tumors is a safe and effective procedure. The advantages of this method are biological inertness of cryonecrosis hearth and easy technique.