Abstract
Objective.To evaluate the effectiveness of preoperative coagulation of the vein adjacent to a tumor nodule in sonographically-guided percutaneous radiofrequency thermal ablation of perivascular liver metastases of colorectal cancer.Materials and methods.To address the issue, we compared the results of sonographically-guided percutaneous radiofrequency thermal ablation of perivascular liver metastases of colorectal cancer in 27 patients (aged 60.5 (58; 68) years) without prior coagulation of the adjacent vein (control group) and 26 patients (62.0 (60; 74)) with prior coagulation of the adjacent vein (experimental group).Results.Lower incidence of residual tumor in the ablation area in the patients with prior coagulation of the adjacent vein (14.3 % vs. 29 % of the patients in the control group) and a higher relapse-free survival of such patients (65.2 % vs. 53.6 % and 55.6 % vs. 33.3 %) were reported as compared to the group without prior coagulation of the adjacent vein (after 6 and 12 months, respectively).Conclusion.Preoperative coagulation of the vein adjacent to colorectal cancer liver metastasis allows reducing the effect of heat removal from the RFA zone, thereby contributing to higher radicality of the treatment and resulting both in a lower incidence of residual tumor in the ablation zone and a higher relapse-free survivalof patients, notably without signifcant concomitant changes in the affected part of the liver (segment atrophy).
Highlights
Primary tumor in the hepatic portal system is the most common cause of liver metastases [1]
Either case can result in reduced radicality of the management of metastases during radiofrequency ablation (RFA) due to the heat removal effect [2,3,4,5].The latter generally manifests when the size of a vessel is 3 mm or more [10].such an effect entails a high risk of residual tumor cell persistence in the transition zone due to the heat removal from the RFA zone by the vessel adjacent to the tumor
This dictates the need for vein occlusion before performing RFA of the metastatic lesion [14]
Summary
Primary tumor in the hepatic portal system is the most common cause of liver metastases [1]. Either case can result in reduced radicality of the management of metastases during radiofrequency ablation (RFA) due to the heat removal effect [2,3,4,5].The latter generally manifests when the size of a vessel (vein) is 3 mm or more [10].such an effect entails a high risk of residual tumor cell persistence in the transition zone due to the heat removal from the RFA zone by the vessel adjacent to the tumor This dictates the need for vein occlusion (if its diameter is 3 mm or more) before performing RFA of the metastatic lesion [14]. Needless to say that in such a situation there emerged a need to search for a different way to avoid the heat removal effect
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