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Percutaneous ablation of post-surgical solitary early recurrence of colorectal liver metastases is an effective “test-of-time” approach

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Abstract

Standard treatment of early recurrence of colorectal liver metastases (CLM) after liver resection (LR) is chemotherapy followed by loco-regional therapy. We reviewed the outcome of a different strategy (“test-of-time” approach): upfront percutaneous ablation without chemotherapy. Twenty-six consecutive patients with early solitary liver-only recurrence amenable to both resection and ablation (< 30 mm, distant from vessels) undergone “test-of-time” approach were analyzed. Early recurrence had a median size of 17 mm and occurred after a median interval from LR of 4 months. Primary efficacy rate of ablation was 100%. Five patients are alive and disease-free after a mean follow-up of 46 months. Five patients had local-only recurrence; all had repeat treatment (LR = 4; Ablation = 1) without chemotherapy. Local recurrence risk was associated with incomplete ablation of 1-cm thick peritumoral margin. The remaining 16 patients had non-local recurrence, 13 early after ablation. Overall, six (23%) patients had ablation as unique treatment and 13 (50%) avoided or postponed chemotherapy (mean chemotherapy-free interval 33.5 months). Ablation without chemotherapy of early liver-only recurrence is a reliable “test-of-time” approach. It minimized the invasiveness of treatment with good effectiveness and high salvageability in case of local failure, avoided worthless surgery, and saved chemotherapy for further disease progression.

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Acknowledgements

The authors thank Marco Solbiati (RAW-Endosight, Milan, Italy) for his contribution in imaging analysis with the Ablation-fitTM software.

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Authors and Affiliations

  1. Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy

    Luca Vigano, Jacopo Galvanin, Daniele Del Fabbro, Damiano Gentile & Guido Torzilli

  2. Department of Radiology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy

    Dario Poretti, Vittorio Pedicini & Luigi Solbiati

  3. Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy

    Luca Vigano, Jacopo Galvanin, Damiano Gentile, Luigi Solbiati & Guido Torzilli

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  1. Luca Vigano
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Vigano, L., Galvanin, J., Poretti, D. et al. Percutaneous ablation of post-surgical solitary early recurrence of colorectal liver metastases is an effective “test-of-time” approach. Updates Surg 73, 1349–1358 (2021). https://doi.org/10.1007/s13304-021-01047-x

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