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Planned Treatment of Advanced Metastatic Disease with Completion Ablation After Hepatic Resection

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Purpose

The aim of this study is to describe a modified treatment strategy with image-guided percutaneous ablation after hepatic resection as a completion method to surgical eradication of liver metastases (“completion ablation [CA]”).

Methods

We conducted a retrospective analyses of patients who underwent CA within 180 days from the liver surgical resection to eradicate liver metastases present on the pre-surgical cross-sectional imaging or identified during intraoperative ultrasound that were not resected due to various reasons. Lesions treated with CA were evaluated for local tumor progression (LTP). Patients were evaluated for hepatic- and overall-recurrence-free survivals (hepatic-RFS and overall-RFS, respectively) and overall survival (OS).

Results

Sixteen patients (10 females; median age 55 years, range 28–69) underwent CA of 21 lesions (median size 8 mm, range 6 to 22). Indications for the use of CA were small future liver remnant in 10 (63%), inability to identify the lesion during surgical exploration in 3 (19%), and technical difficulty of resection in 3 (19%) patients. No liver-related complications were recorded following the surgical resection or the CA procedures. Primary and secondary CA efficacy rates were 95 and 100%, respectively. LTP was 0% at a median clinical follow-up of 27 months (range 4.0–108 months). Five-year hepatic-RFS, overall-RFS, and OS were 36, 16, and 51%, respectively.

Conclusion

The use of CA as a complement to surgical resection is safe and effective. Such approach could potentially expand the surgical candidacy for patients with limited liver functional reserve and reduce postoperative morbidity and mortality in this selected patient population with more advanced disease.

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Authors’ Contributions

Criteria #1:

Design and study conception: BCO, SY, JNV

Acquisition of data: BCO, SY, LF, SG, SYH

Analysis and interpretation: BCO, SY, JNV, MEH, SEK, TAA, YSC, KA, SG

Criteria #2:

Drafting: BCO, SY, JNV

Revising: BCO, SY, LF, SYH, SEK, KA, YSC, TAA, MEH, SG, JNV

Criteria #3:

All authors approved the final version.

Criteria #4:

All authors agreed to be accountable for all aspects of the work.

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Authors and Affiliations

  1. Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1471, Houston, TX, 77030, USA

    Bruno C. Odisio, Livia Frota, Steven Y. Huang, Kamran Ahrar, Marshall E. Hicks & Sanjay Gupta

  2. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Suguru Yamashita, Yun Shin Chun, Thomas A. Aloia & Jean-Nicolas Vauthey

  3. Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Scott E. Kopetz

Authors
  1. Bruno C. Odisio
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  2. Suguru Yamashita
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  3. Livia Frota
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  6. Kamran Ahrar
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  11. Jean-Nicolas Vauthey
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Correspondence to Bruno C. Odisio.

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Odisio, B.C., Yamashita, S., Frota, L. et al. Planned Treatment of Advanced Metastatic Disease with Completion Ablation After Hepatic Resection. J Gastrointest Surg 21, 628–635 (2017). https://doi.org/10.1007/s11605-016-3324-7

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  • DOI: https://doi.org/10.1007/s11605-016-3324-7

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