Hepato-pericardial fistula following radiofrequency ablation (RFA) for liver metastasis: a case report and review of the literature

Introduction  Recent large-scale studies have demonstrated the efficiency and safety of radiofrequency ablation (RFA) for unresectable hepatic tumors. Nevertheless, severe side effects especially relating to non-target thermal injury have occurred after radiofrequency ablation. Case report  We observed the development of a hepato-pericardial fistula leading to pericardial empyema after RFA of a metastatic hepatic lesion. Concerning the genesis of the fistula, development from thermal damages in the diaphragm and pericardium as well as abscess formation in the liver is assumed. Treatment consisted of percutaneous drainage and flushing via remaining hepatic and pericardial catheters. Recovery was achieved conservatively after 2 months. To the best of our knowledge, a hepato-pericardial fistula as a complication of RFA has not been reported so far. The review of the literature revealed several cases of intrahepatic abscess formation after RFA as well as one case of pericardial empyema due to perforation of hepatic amoebic abscess. Two cases of pericardial tamponade after RFA are reported in the literature leading to death. Treatment via percutaneous drainage has been successful in this case and correlates with the successful treatment of abscess formation after RFA of metastatic pancreatic cancer. Other authors suggest pericardectomy or thoracotomy in the treatment of pericardial empyema. Conclusion  The management of hepatic abscess formation subsequent to RFA of metastatic hepatic malignancies is not well described. We regard the percutaneous drainage as treatment of pericardial empyema as well as hepatic abscess as less invasive and sufficient, as demonstrated in this case.     

Radiofrequency ablation: a novel primary and adjunctive ablative technique for hepatic malignancies.

The majority of primary and metastatic tumors of the liver are not amenable to surgical resection at presentation. Radiofrequency ablation (RFA) is a new modality for local tumor destruction with minimal local and systemic complications. We prospectively reviewed the experience with RFA at a single institute as a primary or adjunctive ablative technique in the treatment of hepatic malignancies. Between November 1997 and December 1998, 30 patients with primary or metastatic hepatic lesions were treated with RFA at the John Wayne Cancer Institute and the Cancer Center at Century City Hospital. Pathology of the treated lesions included colorectal metastases (29 in 14 patients), neuroendocrine metastases (29 in 4 patients), noncolorectal metastases (29 in 9 patients), and hepatocellular carcinoma (6 in 3 patients). Twelve patients underwent RFA laparoscopically, 12 at celiotomy, and the remaining 6 patients had percutaneous ablation. RFA was the only procedure in 17 patients, whereas the remainder underwent a combination of RFA and other procedures including resection, cryosurgical ablation, and hepatic artery infusion pump placement. Median length of stay for all patients was 6 days (2 days for laparoscopic patients). A single complication of a delayed intrahepatic abscess was noted in this series (3%). There have been no deaths associated with RFA. At a median follow-up of 5 months, 16 patients remain disease free, and 10 are alive with disease. RFA is a safe and effective method of tumor ablation for hepatic malignancies. This technique can be performed laparoscopically, at celiotomy, or percutaneously and can be used as a primary technique or in conjunction with other interventional procedures.     

Radiofrequency ablation treatment of refractory carcinoid hepatic metastases

BACKGROUND: Our institution has experienced excellent success using hepatic artery embolization for treating symptoms and slowing tumor progression for patients with unresectable hepatic metastases for carcinoid tumors. Our previous treatment strategies used hepatic artery embolization alone, examining control of symptoms and dependence on octreotide therapy. However, some patients exhibit hepatic metastases that are unresponsive to embolization. This report describes the use of radiofrequency ablation (RFA) as salvage treatment for these refractory metastases. METHODS: Thirteen patients with unresectable bilobar hepatic metastases from biochemically confirmed carcinoid tumors were treated with selective hepatic artery embolization using Lipiodol/Gelfoam between 1994 and 2000. Three patients developed symptoms resistant to embolization treatment resulting from progression of existing metastases or development of new metastases. These patients underwent surgical exploration and intraoperative ultrasound of their refractory lesions, followed by treatment with RFA. Tumor size, symptoms of carcinoid syndrome, and octreotide requirements were monitored postoperatively. RESULTS: Median follow-up for the three patients treated with RFA was 6 months. During the first 3-month interval following RFA, all three patients demonstrated decrease in the size of treated lesions. Using our previously developed symptom scoring system, all three patients demonstrated decreased symptoms following treatment. One patient was able to discontinue octreotide treatment, and the other two patients required decrease octreotide dosages. CONCLUSIONS: This study demonstrates that utilization of RFA treatment for carcinoid metastases refractory to hepatic artery embolization may represent a useful adjunct for symptomatic control, decreased octreotide dependence, and slowing of disease progression.     

Laparoscopic radiofrequency ablation of neuroendocrine liver metastases: a 10-year experience evaluating predictors of survival

BACKGROUND: A decade ago we reported the first use of laparoscopic radiofrequency thermal ablation (RFA) for the treatment of neuroendocrine hepatic metastases. This study analyzes our 10-year experience and determines characteristics predictive of survival. METHODS: Eighty RFA sessions were performed in 63 patients with neuroendocrine hepatic metastases in a prospective trial. All patients had unresectable disease with computed tomography (CT) documented lesion and/or symptom progression. Perioperative morbidity, symptom relief, disease progression, and long-term survival were analyzed. Data are expressed as mean +/- standard error of the mean (SEM). RESULTS: There were 22 women and 41 men, age 54.4 +/- 1.5 years followed for 2.8 +/- 0.3 years (range, 0.1 to 7.8). Tumor types included 36 carcinoid, 18 pancreatic islet cell, and 9 medullary thyroid cancer. RFA was performed 1.6 +/- 0.3 years after the diagnosis of liver metastases. Number of lesions treated was 6 +/- 0.5 (range, 1 to 16). Forty-nine patients underwent 1 ablation session, and 14 (22%) had repeat sessions caused by disease progression. Mean hospital stay was 1.1 days. Perioperative morbidity was 5%, with no 30-day mortality. Fifty-seven percent of patients exhibited symptoms. One week postoperatively 92% of these reported at least partial symptom relief, and 70% had significant or complete relief. Duration of symptom control was 11 +/- 2.3 months. CT follow-up demonstrated 6.3% local tumor recurrence. Larger dominant liver tumor size and male gender adversely impacted survival (P < .05). Median survival times were 11.0 years postdiagnosis of primary tumor, 5.5 years postdiagnosis of neuroendocrine hepatic metastases, and 3.9 years post-1st RFA. Survival for patients undergoing repeat ablation sessions was not significantly lower. CONCLUSIONS: This study represents the largest series of neuroendocrine hepatic metastases treated by RFA. In this group of patients with aggressive neuroendocrine tumor metastases and limited treatment options, RFA provides effective local control with prompt symptomatic improvement.     

Two-stage surgical treatment of unresectable obstructive rectal cancer with synchronous hepatic metastases

Unresectable obstructing rectal cancer with synchronous hepatic metastases is usually a fatal disease. This prospective study was scheduled to treat this difficult condition using a multimodal curative strategy combined with a two-stage surgical treatment. Patients with T4N2 or N3M1 rectal cancer and hepatic metastases underwent a two-stage surgical treatment; in the first stage, a decompressing colostomy plus radiofrequency ablation (RFA) in liver metastases. In the second stage, a colectomy was done with stoma closing and resection of superficial necrotic hepatic tumors, plus repetition of RFA in recurrent or new hepatic tumors. Four patients were included, with 1 to 8 (total 20) hepatic metastases, each <5 cm in diameter. In the first stage, two patients were operated on by open approach and two laparoscopically. All hepatic tumors were treated by RFA to produce at least a 1-cm tumor-free margin. After chemoradiation of the rectal tumor, the second stage of surgical treatment was successful in colectomies and stoma closing. Three had complete necrosis of hepatic tumors and one a recurrent tumor plus two new metastases treated by RFA. Two patients died 14 and 42 months after the first stage of surgical treatment, and the other two patients are alive. One of them is disease-free 54 months after the first stage and the other with new recurrence 52 months after the first stage of the procedure. The multimodal curative strategy for the treatment of unresectable obstructing rectal cancer with synchronous hepatic metastases, containing a two-stage surgical treatment with RFA of hepatic metastases and chemoradiation of the rectal tumor between the two stages of the procedure, is a promising method. A larger number of patients with long-term follow-up is necessary to confirm these findings.     

腹腔镜下一期行结直肠癌切除与多电极射频治疗肝转移癌

目的探讨腹腔镜下行乙状结肠、直肠癌切除,同时多电极射频治疗肝转移癌方法的临床价值。方法对6例术前确诊为乙状结肠、直肠癌,经CT发现肝脏有实性占位的患者,行腹腔镜下乙状结肠、直肠癌切除,吻合器吻合肠段后,再在腹腔镜直视下行肝脏肿瘤穿刺病理学检查,确诊为肝转移癌后,即经皮多电极针穿刺进入肝肿瘤进行射频消融治疗。结果6例患者治疗中未发生严重并发症,术后肠道功能恢复时间24～72h。术后3个月CT复查发现肿瘤明显液化并完全坏死;存活4例,其中1例又再做肝移植至今;2例死于全身衰竭。结论腹腔镜下应用多电极射频消融治疗乙状结肠、直肠癌伴肝转移癌是安全有效的,避免了二期手术的创伤和不良预后。     

18F]Fluorodeoxyglucose positron emission tomography surveillance of hepatic metastases from prostate cancer following radiofrequency ablation: a case report

The liver is the organ most commonly involved with metastatic disease. Surgical resection of hepatic metastases is the only potentially curative therapy, but it is possible in only 20 per cent of the patients. Radiofrequency ablation (RFA) of hepatic lesions is a therapeutic option for unresectable hepatic metastases. Today there is no clear consensus about which imaging technique is the most reliable to monitor RFA therapy. [18F]Fluorodeoxyglucose (FDG) positron emission tomography (PET) is a new imaging modality allowing evaluation of glucose metabolism that has become established for monitoring therapy and early detection of recurrence of various types of malignant tumors. We present a case report of a 61-year-old man treated for prostate carcinoma 3 years earlier who presented with rising serum prostate-specific antigen (PSA) levels. A CT scan demonstrated two hepatic metastases that were treated with RFA because the patient refused surgery. During 3 years of follow-up hepatic recurrence was monitored with serum PSA levels, CT of the abdomen, and FDG-PET imaging on multiple occasions. On three separate occasions FDG-PET revealed hypermetabolic foci despite no definite evidence of recurrence on CT. Furthermore FDG-PET imaging 2 months after the last RFA therapy showed two large photopenic areas without evidence of hypermetabolism consistent with successful RFA therapy. Serum PSA levels correlated better with FDG-PET than CT results. We conclude that in this patient FDG-PET imaging was more accurate than CT for monitoring recurrence of hepatic metastases from prostate carcinoma after RFA therapy. PET demonstrated hypermetabolic foci when there was recurrence and no evidence of hypermetabolism early after successful RFA therapy. In addition FDG-PET imaging helped to guide the placement of the RFA probe to the most metabolically active part of the tumor.     

Surgical and ablative treatment for metastatic adenocarcinoma to the liver from unknown primary tumor

Metastatic adenocarcinoma to the liver from an unknown primary tumor (UPT) carries a poor prognosis, with a median survival of 5 months. Chemotherapy has not significantly improved outcome, and effective treatment is yet to be established in these patients. We examined our experience with surgical resection and ablation of this disease to determine clinico-pathologic characteristics and treatment outcomes. We undertook a retrospective chart review of 157 patients who were treated for metastatic disease to the liver with resection or radiofrequency ablation (RFA) between 1999 and 2003. Seven patients were identified with unknown primary malignancy. Evaluation of the seven patients included complete history and physical examination, complete blood count, routine chemistries, stool Hemoccult test, chest radiograph, and computed tomography (CT) of the abdomen and pelvis. In addition, the three female patients had breast examinations and mammography. Adenocarcinoma histology was determined via CT-guided liver biopsy in all patients. Other diagnostic tests, including whole-body positron emission tomography to the measurement of various serum tumor markers, were performed in the majority of the patients. There were nine total lesions treated; six with RFA and three with hepatic resection. Median diameter of the lesions was 5.4 cm (range, 1.3-15). Two patients were treated with adjuvant and three patients with neoadjuvant and adjuvant chemotherapy. Extrahepatic sites of metastases, adrenal and skeletal, were discovered in 1 patient prior to treatment. With a median follow-up of 9 months, 1 patient is currently alive with no evidence of disease, 4 patients are alive with disease, and 2 patients died of disease. Median disease-free-interval following treatment was 6.5 months. To date, optimal treatment for metastatic adenocarcinoma to the liver UPT remains unclear. Localized treatment involving RFA or hepatic resection may be a promising addition to chemotherapy in the management of this disease.     

Skin implant metastasis after percutaneous radio-frequency therapy of liver metastasis of a colorectal carcinoma

Percutaneous radio-frequency ablation (RFA) of liver tumors has been reported to be an effective approach. Skin implant metastases have been described after RFA of hepatocellular carcinoma. A 56-year-old man underwent resection of the transverse colon for an adenocarcinoma (pT3N2M0) following by adjuvant chemotherapy. He developed multiple liver metastases and underwent RFA. Six weeks after RFA, the patient noticed a painful skin lesion at the entrance side of the probe in the right upper abdominal quadrant. Ultrasound examination and computed tomography scan revealed an intracutaneous tumor of 2-cm diameter. The tumor was excised and revealed a metastasis of the previously described adenocarcinoma. CPT-11 monotherapy was started; however, due to tumor progression, the patient died 35 months after colonic resection and 10 months after RFA. This is the first case of an implant skin metastasis after RFA of secondary liver tumors. Although RFA is a promising option in the palliation of such tumors, such rare complications have to be considered.     

Colonic fistula associated with severe acute pancreatitis: Report of two cases

Colonic fistula is a rare and potentially critical sequela of severe acute pancreatitis, which requires surgical treatment. We report two cases that were successfully treated by a colectomy for colonic fistula associated with severe acute pancreatitis. Case 1 is a 71-year-old man infected with pseudocysts owing to severe acute pancreatitis that developed into a colonic fistula as an early complication with a resulting pancreatic abscess. This patient underwent a left hemicolectomy, a transverse colostomy, and drainage of the pancreatic abscess. He has done well without recurrent disease for 35 months following surgery. Case 2 is a 58-year-old woman who had a past history of drainage during a laparotomy for a pancreatic abscess induced by endoscopic retrograde cholangiopancreatography 10 years earlier. She was admitted to our hospital with left lateral abdominal pain and low-grade fever. Abdominal magnetic resonance imaging showed a retroperitoneal abscess and fistula to the descending colon. She underwent a left hemicolectomy and drainage of the retroperitoneal abscess. She has remained symptom-free for 20 months following surgery. The colonic fistula should therefore be recognized as a late complication during long-term follow-up as well as an early sequela associated with severe acute pancreatitis.     

Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases

OBJECTIVE: To examine recurrence and survival rates for patients treated with hepatic resection only, radiofrequency ablation (RFA) plus resection or RFA only for colorectal liver metastases. SUMMARY BACKGROUND DATA: Thermal destruction techniques, particularly RFA, have been rapidly accepted into surgical practice in the last 5 years. Long-term survival data following treatment of colorectal liver metastasis using RFA with or without hepatic resection are lacking. METHODS: Data from 358 consecutive patients with colorectal liver metastases treated for cure with hepatic resection +/- RFA and 70 patients found at laparotomy to have liver-only disease but not to be candidates for potentially curative treatment were compared (1992-2002). RESULTS: Of 418 patients treated, 190 (45%) underwent resection only, 101 RFA + resection (24%), 57 RFA only (14%), and 70 laparotomy with biopsy only or arterial infusion pump placement ("chemotherapy only," 17%). RFA was used in operative candidates who could not undergo complete resection of disease. Overall recurrence was most common after RFA (84% vs. 64% RFA + resection vs. 52% resection only, P < 0.001). Liver-only recurrence after RFA was fourfold the rate after resection (44% vs. 11% of patients, P < 0.001), and true local recurrence was most common after RFA (9% of patients vs. 5% RFA + resection vs. 2% resection only, P = 0.02). Overall survival rate was highest after resection (58% at 5 years); 4-year survival after resection, RFA + resection and RFA only were 65%, 36%, and 22%, respectively (P < 0.0001). Survival for "unresectable" patients treated with RFA + resection or RFA only was greater than chemotherapy only (P = 0.0017). CONCLUSIONS: Hepatic resection is the treatment of choice for colorectal liver metastases. RFA alone or in combination with resection for unresectable patients does not provide survival comparable to resection, and provides survival only slightly superior to nonsurgical treatment.     

Successful video-thoracoscopic drainage for descending necrotizing mediastinitis

Descending necrotizing mediastinitis (DNM) is a rare but severe disease with a high mortality rate. We report a case of a 77-year-old woman with DNM who was treated using video-thoracoscopic drainage and a Blake drain. She was admitted to our hospital with a 3-day history of a sore throat. Computed tomography (CT) revealed a peritonsillar abscess descending into the anterior and posterior mediastinum below the carina. She was diagnosed with DNM, and emergency surgery was performed. The mediastinal abscess was drained via video-thoracoscopy, and a 24F Blake drain was inserted into the mediastinum. Following mediastinal drainage, cervical drainage was performed for treatment of the retropharyngeal abscess. The outcome of videothoracoscopic mediastinal drainage was satisfactory, and no further invasive treatment was required. We believe that video-thoracoscopic mediastinal drainage is an effective, minimally invasive treatment for DNM with subcarinal spread. Blake drains are useful for mediastinal drainage.     

Laparoscopic radiofrequency ablation of liver tumors combined with colorectal procedures

Laparoscopic radiofrequency ablation (RFA) is gaining increasing acceptance as a treatment option for primary and secondary liver tumors with minimal morbidity. The purpose of this study is to see if adding a colorectal procedure to RFA increases the risk of hepatic abscess. Of the 310 patients with 1,080 primary and secondary liver tumors undergoing laparoscopic radiofrequency ablation (RFA), 16 patients underwent RFA in combination with various colorectal procedures. Data were collected prospectively. The concomitant procedures included loop ileostomy closures in 6 patients; laparoscopic-assisted right hemicolectomy in 3 patients; laparoscopic-assisted anterior resection in 2 patients; and open transverse colectomy, open anterior resection, open low anterior resection, open loop transverse colostomy formation, and anal stricture dilatation in 1 patient each. Mean +/- SD hospital stay was 2.9 +/- 1.7 days. There was no mortality, and the only complication was the development of a right flank abscess after laparoscopic-assisted right hemicolectomy that was treated with percutaneous drainage. Although patients undergoing laparoscopic RFA in combination with a clean-contaminated procedure could be at high risk for secondary infection of ablated foci, this was not observed. This approach is safe and does not impair recovery from either procedure. These data support the concept that RFA may be safely used with concomitant colon resections to treat liver metastases that may be resectable but are associated with increased morbidity if resected synchronously.     

Learning Curve for Percutaneous Radiofrequency Ablation of Pulmonary Metastases From Colorectal Carcinoma: A Prospective Study of 70 Consecutive Cases

Background Percutaneous radiofrequency ablation (RFA) for inoperable colorectal pulmonary metastases is associated with a morbidity rate of 30% to 40%. A learning curve in this treatment approach has not been documented before.Methods The clinical and treatment-related data regarding 70 consecutive percutaneous RFA procedures for inoperable colorectal pulmonary metastases were collected prospectively. A comparison between the initial 35 cases (group 1) and the subsequent 35 cases (group 2) was performed. Univariate and multivariate analyses were conducted to identify the significant risk factors for overall morbidity, pneumothorax, and chest drain requirement.Results There was no hospital mortality. The overall morbidity rate was 37%. The rate of pneumothorax was 27%. Twelve patients (17%) required chest drain insertion for pneumothorax. There was a significant decline in the incidence of overall morbidity, pneumothorax, and chest drain requirement in group 2 as compared with group 1. Both the number of lung metastases ablated and the RFA treatment period (group 1 vs. group 2) were independent risk factors for overall morbidity, pneumothorax, and chest drain requirement. Distribution of lung metastases (unilateral vs. bilateral) was an independent risk factor for overall morbidity and pneumothorax, but not for chest drain requirement.Conclusions There is a learning curve for percutaneous lung RFA. With accumulated experience in this procedure, a low morbidity rate can be achieved.     

Adenovirus-mediated delivery of a soluble form of the VEGF receptor Flk1 delays the growth of murine and human pancreatic adenocarcinoma in mice

BACKGROUND: Because pancreatic adenocarcinoma is poorly responsive to chemotherapy and radiation therapy, novel treatments such as antiangiogenic gene therapy may have use in the adjuvant treatment of this malignancy. We evaluated the antitumor effects of the in vivo administration of an adenovirus vector encoding a soluble form of Flk1 (Flk1-Fc), a receptor for vascular endothelial growth factor, in 3 murine models of pancreatic adenocarcinoma. METHODS: In a first model, immunocompetent C57Bl/6 mice were injected subcutaneously with Panc02 murine pancreatic adenocarcinoma cells before treatment. In a second model, immunodeficient severe combined immunodeficiency mice were injected subcutaneously with BxPc-3 human pancreatic adenocarcinoma cells before treatment. In a third model, C57Bl/6 mice were injected with Panc02 cells through an intrasplenic route before treatment, in an effort to model metastatic disease. In each model, half the tumor-bearing mice were injected intravenously with 10(9) Flk1-Fc adenovirus particles and half with control adenovirus. RESULTS: In subcutaneous tumor models, Ad Flk1-Fc-treated animals were found to have 75% smaller murine and 78% smaller human pancreatic tumor volumes, relative to tumor volumes of Ad Fc-treated animals, 6 weeks after vector administration. In animals injected with tumor through the intrasplenic route, pathologic and histologic analyses made 10 days after injection of tumor revealed hepatic, pancreatic, and splenic tumors, together with a desmoplastic response consistent with pathologic findings in human pancreatic cancer. Cohorts of these tumor-bearing mice treated with Ad Flk1-Fc demonstrated significantly longer survival and decreased liver replacement with tumor at the time of death, relative to animals treated with Ad Fc. CONCLUSION: A recombinant adenovirus encoding soluble Flk-1 inhibited pancreatic tumor growth in mice. These studies suggest that the delivery of gene products such as Flk1-Fc through in vivo gene transfer may be useful in the future treatment of patients with pancreatic cancer.     

Streptozotocin effective for treating multiple-hormone-producing malignant islet cell tumor

A woman with a multiple-hormone-producing pancreatic islet cell tumor with hepatic metastases and with recurrent hypoglycemic attacks, was treated with steptozotocin. After this treatment, the elevated serum levels of insulin, C-peptide, glucagon and serotonin fell markedly and the low level of fasting blood glucose returned to normal. In accordance with these hormonal changes, scintiscan and CT scan revealed marked regression of the metastatic tumors in the liver. She is alive at this writing, five years after the streptozotocin treatment. Streptozotocin should thus be considered for treatment of malignant islet cell carcinoma with liver metastases and which is not amenable to surgery. Presented at the 6th World Congress of the Collegium Internationale Chirurgiae Digestivae, Lisbon, Portugal, September 19, 1980     

Radio-frequency ablation of large, nonresectable hepatic tumors

Patients with nonresectable hepatic metastases who are not treated survive an average of 6 months. We report our experience with radio-frequency ablation (RFA) of nonresectable hepatic tumors 4 cm or greater in size. A retrospective chart review of all patients undergoing RFA of hepatic tumors 4 cm or greater from October 1, 1999, through August 31, 2002, was performed. Thirty-six patients were identified who underwent RFA of tumors 4 cm or greater. There were a total of 81 tumors ablated in the 36 patients. Twenty patients underwent RFA only; seven patients received RFA plus a wedge resection. Five patients were treated with RFA followed by chemoembolization. Two patients underwent RFA plus placement of a hepatic artery infusion pump. The median tumor size was 5 cm (range, 4-14 cm). Median patient follow-up was 26 months (range, 1-54 months). Patients with metastatic colon cancer had the longest median survival of 28 months (range, 1 and 48 months). The survival of primary hepatocellular carcinoma was worse with a median survival of 20 months (range, 1-36 months). At last follow-up, 11 (30%) of the patients remain alive and disease free. There were no perioperative deaths and one intraoperative complication. In our experience, RFA of larger tumors is effective and safe. Tumor size should not be an absolute contraindication to RFA of nonresectable hepatic tumors.     

Feasibility of adjuvant hepatic arterial infusion of chemotherapy after radiofrequency ablation with or without resection in patients with hepatic metastases from colorectal cancer

Background: The safety of combined hepatic artery infusion chemotherapy (HAI) and radiofrequency ablation (RFA) for liver metastases has not been assessed. We conducted a study to determine the feasibility of using HAI after RFA for colorectal cancer (CRC) liver metastases.Methods: Between 1996 and 2001, patients with hepatic metastases from CRC were enrolled onto a prospective study of RFA plus HAI consisting of continuous-infusion floxuridine and bolus fluorouracil. Surgical complications, treatment-related toxicities, and patient outcomes were recorded.Results: Fifty patients were treated with RFA and HAI with or without resection. A median of two lesions per patient, with a median greatest diameter of 2.0 cm, were treated with RFA. Postoperative complications, including 1 death, occurred in 11 of 50 patients. Toxicity from HAI was relatively mild. At 20 months median follow-up, 32% of patients remained disease free. Ten percent of patients had recurrences at the site of RFA, 30% developed new liver metastases, and 48% developed extrahepatic disease.Conclusions:RFA of CRC liver metastases followed by HAI is feasible and is associated with acceptable complication and toxicity rates. The high rate of disease recurrence in our patients indicates that novel combinations of regional and systemic therapies are needed to improve patient outcomes.     

Combined Resection and Radiofrequency Ablation for Advanced Hepatic Malignancies: Results in 172 Patients

Background: Resection combined with radiofrequency ablation (RFA) is a novel approach in patients who are otherwise unresectable. The objective of this study was to investigate the safety and efficacy of hepatic resection combined with RFA.Methods: Patients with multifocal hepatic malignancies were treated with surgical resection combined with RFA. All patients were followed prospectively to assess complications, treatment response, and recurrence.Results: Seven hundred thirty seven tumors in 172 patients were treated (124 with colorectal metastases; 48 with noncolorectal metastases). RFA was used to treat 350 tumors. Combined modality treatment was well tolerated with low operative times and minimal blood loss. The postoperative complication rate was 19.8% with a mortality rate of 2.3%. At a median follow-up of 21.3 months, tumors had recurred in 98 patients (56.9%). Failure at the RFA site was uncommon (2.3%). A combined total number of tumors treated with resection and RFA >10 was associated with a faster time to recurrence (P = .02). The median actuarial survival time was 45.5 months. Patients with noncolorectal metastases and those with less operative blood loss had an improved survival (P = .03 and P = .04, respectively), whereas radiofrequency ablating a lesion >3 cm adversely impacted survival (HR = 1.85, P = .04).Conclusions: Resection combined with RFA provides a surgical option to a group of patients with liver metastases who traditionally are unresectable, and may increase long-term survival.     

Radiofrequency ablation and percutaneous ethanol injection treatment for recurrent local and distant well-differentiated thyroid carcinoma

OBJECTIVE: To assess the long-term efficacy of radiofrequency ablation (RFA) and percutaneous ethanol (EtOH) injection treatment of local recurrence or focal distant metastases of well-differentiated thyroid cancer (WTC). BACKGROUND: RFA and EtOH injection techniques are new minimally invasive surgical alternatives for treatment of recurrent WTC. We report our experience and long-term follow-up results using RFA or EtOH ablation in treating local recurrence and distant focal metastases from WTC. METHODS: Twenty patients underwent treatment of biopsy-proven recurrent WTC in the neck. Sixteen of these patients had lesions treated by ultrasound-guided RFA (mean size, 17.0 mm; range, 8-40 mm), while 6 had ultrasound-guided EtOH injection treatment (mean size, 11.4 mm; range, 6-15 mm). Four patients underwent RFA treatment of focal distant metastases from WTC. Three of these patients had CT-guided RFA of bone metastases (mean size, 40.0 mm; range, 30-60 mm), and 1 patient underwent RFA for a solitary lung metastasis (size, 27 mm). Patients were then followed with routine ultrasound, I whole body scan, and/or serum thyroglobulin levels for recurrence at the treatment site. RESULTS: No recurrent disease was detected at the treatment site in 14 of the 16 patients treated with RFA and in all 6 patients treated with EtOH injection at a mean follow-up of 40.7 and 18.7 months, respectively. Two of the 3 patients treated for bone metastases are free of disease at the treatment site at 44 and 53 months of follow-up, respectively. The patient who underwent RFA for a solitary lung metastasis is free of disease at the treatment site at 10 months of follow-up. No complications were experienced in the group treated by EtOH injection, while 1 minor skin burn and 1 permanent vocal cord paralysis occurred in the RFA treatment group. CONCLUSIONS: RFA and EtOH ablation show promise as alternatives to surgical treatment of recurrent WTC in patients with difficult reoperations. Further long-term follow-up studies are necessary to determine the precise role these therapies should play in the treatment of recurrent WTC.