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Local Recurrence After Laparoscopic Radiofrequency Thermal Ablation of Hepatic Tumors

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Abstract

Background: Since we first described laparoscopic radiofrequency ablation (LRFA) of liver tumors, several reports have documented technical and safety aspects of this procedure. Little is known, however, about the long-term follow-up of such patients.

Methods: From January 1996 to February 1999, we performed LRFA on 250 liver tumors in 66 patients. Triphasic spiral computed tomographic scanning was obtained preoperatively and at 1 week, and every 3 months postoperatively. Lesion diameter was measured in the x- and y-axes and the volume estimated; 181 lesions in 43 patients for whom computed tomographic scans available were included in the study. The tumor types were as follows: 64 metastatic adenocarcinomas, 79 neuroendocrine metastases, 27 other metastases, and 11 primary liver tumors.

Results: One week postoperatively, the ablated zone was larger than the original tumor in 178 of 181 lesions, which suggests ablation of the tumor and a margin of normal liver tissue. A progressive decline in lesion size was seen in 156 (88%) of 178 lesions, followed for at least 3 months (mean, 13.9 months; range, 4.9–37.8 months), which suggests resorption of the ablated tissue. Fourteen definite local treatment failures were apparent by increase in size and change in computed tomographic scan appearance, and eight lesions were scored as failures because of multifocal recurrence that encroached on ablated foci (22 total recurrences). Predictors of failure include lack of increased lesion size at 1 week (2 of 3 such lesions failed), adenocarcinoma or sarcoma (18 of 22 failures; P < .05), larger tumors (failures, M < 18cm3 vs. successes, M < 7cm3; P < .005) and vascular invasion on laparoscopic ultrasonography. By size criteria, 17 of 22 failures were apparent by 6 months. Energy delivered per gram of tissue was not significantly different (P < .45).

Conclusions: LRFA has a 12% local failure rate, with larger adenocarcinomas and sarcomas at greatest risk. Failures occur early in follow-up, with most occurring by 6 months. LRFA seems to be a safe and effective treatment technique for patients with primary and metastatic liver malignancies.

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References

  1. Bengmark S, Hafstrom L. The natural history of primary and secondary malignant tumors of the liver. Cancer 1969;23:198–202.

    PubMed  CAS  Google Scholar 

  2. Silverberg E, Boring CC, Squires TS. Cancer statistics 1990. Cancer Clin 1990;40:9–26.

    CAS  Google Scholar 

  3. Cady B, Stone MD. The role of surgical resection of lover metastases in colorectal carcinoma. Semin Oncol 1991;18:399–406.

    PubMed  CAS  Google Scholar 

  4. Okuda K, Obata H, Nakajima Y, et al. Prognosis of primary hepatocellular carcinoma. Hepatology 1984;4:3–6.

    Article  Google Scholar 

  5. Akerstrom G. Management of carcinoid tumors of the stomach, duodenum, and pancreas. World J Surg 1996;20:173–182.

    PubMed  CAS  Google Scholar 

  6. Di Bartolomeo M, Bajetta E, Buzzoni R, et al. Clinical efficacy of octreotide in the treatment of metastatic neuroendocrine tumors: a study by the Italian trials in medical oncology group. Cancer 1996;77:402–408.

    PubMed  Google Scholar 

  7. Faiss S, Schereubl H, Rieken E, Wiedenmann B. Drug therapy in metastatic endocrine tumors of the gastrointeropancreatic system. Recent Results Cancer Res 1996;142:193–207.

    PubMed  CAS  Google Scholar 

  8. Ravikumar TS. Interstitial therapies for liver tumors: management options in primary and secondary liver cancer. Surg Oncol Clin N Am 1996;5:365–376.

    PubMed  CAS  Google Scholar 

  9. Butler J, Attiyeh FF, Daly JM. Hepatic resection for metastases of the colon and rectum. Surg Gynecol Obstet 1986;162:109–113.

    PubMed  CAS  Google Scholar 

  10. Que FG, Nagorney DM, Batts KP, Linz LJ, Kvols LK. Hepatic resection for metastatic neuroendocrine carcinomas. Am J Surg 1995;169:36–43.

    Article  CAS  PubMed  Google Scholar 

  11. Chen M, Hwang T, Jeng LB, Jan Y, Wang C, Chou F. Hepatic resection in 120 patients with hepatocellular carcinoma. Arch Surg 1989;124:1025–1028.

    PubMed  CAS  Google Scholar 

  12. Arii S, Tanaka J, Yamazoe Y, Minematsu S, et al. Predictive factors for intrahepatic recurrence of hepatocellular carcinoma after partial hepatectomy. Cancer 1992;69:913–919.

    PubMed  CAS  Google Scholar 

  13. Fortner JG. Recurrence of colorectal cancer after hepatic resection. Am J Surg 1988;188:178–182.

    Google Scholar 

  14. Ekberg H, Tranberg K, Andersson R, Lundstedt C, et al. Pattern of recurrence in liver resection for colorectal secondaries. World J Surg 1987;11:541–547.

    CAS  PubMed  Google Scholar 

  15. Ravikumar TS, Kane R, Cady B, et al. A 5-year study of cryosurgery in the treatment of liver tumors. Arch Surg 1991;126:1520–1524.

    PubMed  CAS  Google Scholar 

  16. Amin Z, Donald JJ, Masters A, et al. Hepatic metastases: interstitial laser photocoagulation with real-time US monitoring and dynamic CT evaluation of treatment. Radiology 1993;187:339–347.

    CAS  PubMed  Google Scholar 

  17. Tanaka K, Nakamura S, Numarata K, et al. Hepatocellular carcinoma: treatment with percutaneous ethanol injection and transcatheter arterial embolization. Radiology 1992;185:457–460.

    PubMed  CAS  Google Scholar 

  18. Livraghi T, Bolondi L, Lazzaronis P, et al. Percutaneous ethanol injection in the treatment of hepatocellular carcinoma in cirrhosis: a study on 207 patients. Cancer 1992;69:925–929.

    PubMed  CAS  Google Scholar 

  19. Seifert JK, Junginger T, Morris DL. A collective review of the world literature on hepatic cryotherapy. J R Coll Surg Edinb 1998;43:141–154.

    PubMed  CAS  Google Scholar 

  20. Lounsberry W, Goldschmidt V, Linke C. The early histologic changes following electrocoagulation. J Urol 1961;86:321–329.

    PubMed  CAS  Google Scholar 

  21. McGahan J, Brock J, Tesluk H. Hepatic ablation with use of radio-frequency electrocautery in the animal model. J Vasc Interv Radiol 1992;3:291–297.

    Article  PubMed  CAS  Google Scholar 

  22. Organ L. Electrophysiologic principles of radiofrequency lesion making. Appl Neurophysiol 1976;39:69–76.

    PubMed  Google Scholar 

  23. Rossi S, Di Stasi M, Buscarini E, et al. Percutaneous radiofrequency interstitial thermal ablation in the treatment of small hepatocellular carcinoma. Cancer J 1995;1:73–81.

    CAS  Google Scholar 

  24. Rossi S, Di Stasi MD, Buscarini E. Percutaneous RF interstitial thermal ablation in the treatment of hepatic cancer. Am J Radiol 1996;167:759–768.

    CAS  Google Scholar 

  25. Siperstein AE, Rogers SJ, Hansen PD, Gitomirsky A. Laparoscopic thermal ablation of hepatic neuroendocrine tumor metastases. Surgery 1997;122:1147–1155.

    PubMed  CAS  Google Scholar 

  26. Cella DF, Tulsky DS, Gray G, et al. The functional assessment of cancer therapy scale: development and validation of the general measure. J Clin Oncol 1993;11:570–599.

    CAS  PubMed  Google Scholar 

  27. Karnofsky DA, Burchenal JH. The clinical Evaluation of chemotherapeutic agents in cancer. In: Mcleod CM, ed. Evaluation of chemotherapeutic agents in cancer. New York: Columbia University Press, 1949:191–205.

    Google Scholar 

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Siperstein, A., Garland, A., Engle, K. et al. Local Recurrence After Laparoscopic Radiofrequency Thermal Ablation of Hepatic Tumors. Ann Surg Oncol 7, 106–113 (2000). https://doi.org/10.1007/s10434-000-0106-x

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