Long-term results of percutaneous radiofrequency ablation of unresectable colorectal hepatic metastases: final outcomes

INTRODUCTION

Percutaneous radiofrequency ablation (PcRFA) provides alternative means of treating patients with unresectable colorectal liver metastases. We previously reported our initial experience in 30 patients treated with PcRFA. We present the final long-term results in these 30 patients.

METHODS

The final outcome of the 30 patients treated with PcRFA is reported, 30 months following the initial results published in 2004.

RESULTS

Thirty patients (21 males and 9 females), median age 74.5 (44-85) years, underwent PcRFA for 57 lesions in 60 sessions. The final results in this cohort of patients are reported: 28 dead and 2 lost to follow-up. Median follow-up was 22 (3-53) months. Median size was 31 (8-70) mm. Nineteen lesions required repeat PcRFA. Median ablation time per lesion was 12 (4.5-36) min. Eleven patients received chemotherapy pre-PcRFA and 15 received chemotherapy post-PcRFA. Three patients went on to have limited hepatectomies. Complications occurred in 3 (5%) and median hospital stay was 1 (1-7) day. The median hepatic disease-free survival was 12 (95% CI 6.1-17.9) months and actuarial survival was 23.2 (95% CI 18.5-27.8) months.

CONCLUSION

PcRFA is safe and associated with increased disease-free and overall survival in patients with unresectable colorectal hepatic metastases.

Percutaneous radiofrequency ablation of colorectal hepatic metastases - initial experience. An adjunct technique to systemic chemotherapy for those with inoperable colorectal hepatic metastases

BACKGROUND AND AIM

Most patients with hepatic metastases from colorectal carcinoma are unsuitable for resection. Radiofrequency ablation (RFA) has been applied to such lesions at laparotomy. This study aimed to evaluate the less invasive approach of percutaneous RFA.

METHOD

Patients with unresectable liver metastases identified on cross-sectional imaging were considered for percutaneous RFA either alone or in combination with systemic chemotherapy. Subjects with >6 lesions or lesions of maximum size >70 mm were excluded. Percutaneous RFA was applied under sedation and radiological guidance (CT/US). Treatment effect was determined by follow-up imaging. Actuarial survival was calculated by the Kaplan-Meier analysis.

RESULTS

Thirty patients (21 males), median age 74.5 years (range 44-85 years), underwent percutaneous RFA to 56 lesions during 54 treatment sessions. The median size of lesion was 30 mm (range 8-70 mm). Fifteen lesions were treated more than once because of recurrence or incomplete ablation. The median ablation time per lesion was 12 min (range 4.5-36 min). Eleven patients had pre-procedural chemotherapy and 15 patients received chemotherapy after treatment. There was minimal associated morbidity (5.6% of treatments). Median hospital stay per treatment was 1 day (range 1-7). Median actuarial survival from the date of first percutaneous RFA was 22 months (95% CI 12.9-31.1 months). Eleven patients were alive at the time of data collection.

CONCLUSION

Percutaneous RFA is a safe, well-tolerated intervention for unresectable hepatic metastases which can be repeated, if required. The technique may be associated with prolonged survival in this selected group of subjects. Future studies should consider the role of percutaneous RFA either in place of or as an adjunct to palliative chemotherapy.

Technical aspects and complications of laparoscopic banding for morbid obesity—a radiological perspective

Morbid obesity is a significant clinical problem in the western world. Various surgical restrictive procedures have been described as an aid to weight reduction when conservative treatments fail. Adjustable laparoscopic gastric banding (LAPBAND) has been popularized as an effective, safe, minimally invasive, yet reversible technique for the treatment of morbid obesity. Radiological input is necessary in the follow-up of these patients and the diagnosis of complications peculiar to this type of surgery. In this review we will highlight the technical aspects of radiological follow-up and the lessons learnt over the last 5 years.

Symptomatic malignant gastroesophageal anastomotic leak: management with covered metallic esophageal stents

OBJECTIVE

Gastroesophageal anastomotic leak after cancer resection has a mortality rate of up to 60% and significant morbidity, whatever the mode of treatment. We assessed the efficacy of esophageal stenting as a therapeutic option to reduce the mortality and morbidity associated with symptomatic intrathoracic anastomotic leakage.

SUBJECTS AND METHODS

During a 52-month period, 14 patients had placement of stents for clinically significant postoperative leaks: 10 patients had an esophagogastrectomy and four patients had a total gastrectomy with esophagojejunal anastomosis. Thirteen of 14 patients had tumors that were histologically staged as T3 N1 M0 or worse. Significant anastomotic leaks were revealed by a contrast-enhanced study at 3-28 days after surgery. Stents were inserted in patients in whom the leakage was debilitating or initial conservative treatment had failed. Stenting outcome in terms of clinical and radiologic healing, hospital stay, survival, and complications was assessed.

RESULTS

No procedural morbidity or 30-day mortality occurred. Immediate postprocedural leak occlusion was obtained in all patients. Clinical healing of the leak occurred in 13 (92.8%) of 14 patients, with a median healing time of 6 days. Of the 13 patients, healing occurred within 10 days in 10 patients (76.9%). Eight of these 10 early closures received a knitted nitinol stent (p = 0.02). One patient (7%) died as a consequence of leakage at 135 days. Median survival for all 14 patients was 11 months (Kaplan-Meier method). Complications included five episodes of food blockages in three patients, which required endoscopic clearance, and one case of stent-related upper gastrointestinal hemorrhage. No patients developed anastomotic stricture or occlusive epithelial hyperplasia.

CONCLUSION

Covered esophageal stenting appears to reduce the mortality and morbidity of symptomatic anastomotic leakage after surgery for gastroesophageal cancer. Knitted nitinol stents may be best suited to this purpose.