Laparoscopic radiofrequency thermal ablation of neuroendocrine hepatic metastases: Long-term follow-up
ABSTRACT Since our first report 13 years ago, laparoscopic radiofrequency ablation has been incorporated into the treatment algorithm of patients with neuroendocrine liver metastases. The aim of this study is to report long-term oncologic results.
Eighty-nine patients with neuroendocrine hepatic metastases underwent 119 laparoscopic radiofrequency ablation sessions within 13 years. Data were obtained from a prospective, Institutional Review Board approved database. Univariate Kaplan Meier and multivariate Cox proportional hazards model were used for statistical analyses. Data are expressed as mean ± standard error of the mean.
Thirty-five women and 54 men with a mean age of 56 ± 1.4 years were included in this study. Tumor types included were carcinoid (n = 55), pancreatic islet cell (n = 23), and medullary thyroid cancer (n = 11). Mean tumor size was 3.6 ± 0.2 and the number of lesions was 6 ± 1. Perioperative morbidity was 6%, and 30-day mortality was 1%. Symptom relief was achieved in 97% of patients after radiofrequency ablation. Median follow-up was 30 ± 3 months. Twenty-two percent of patients developed local liver recurrence, 63% developed new liver lesions, and 59% developed extrahepatic disease in follow-up. Repeat radiofrequency ablation (27%) and chemoembolization (7%) were used to achieve additional local tumor control in follow up. Median disease-free survival was 1.3 years and the overall survival was 6 years after radiofrequency ablation. Liver tumor volume, symptoms, and extrahepatic disease were independent predictors of survival.
To our knowledge, this is the largest prospective experience with radiofrequency ablation of neuroendocrine liver metastases. Effective symptom palliation and long-term local tumor control are possible in these patients with minimal morbidity.
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ABSTRACT: Thermal ablation of hepatic tumors has been an evolving field over the last two decades. It is used in the treatment of both primary and metastatic neoplasms, and with evolutions in the technology, there has been an increasing interest in treating lesions where hepatic resection is not an option. Laparoscopic or minimally invasive surgical procedures have also advanced during this same time period, and the interface of these tools has been associated with the genesis of a new approach for treating hepatic lesions which are located in difficult to reach locations or found immediately adjacent to other intra-abdominal organs. This review summarizes the published literature focusing on the treatment of primary and metastatic neoplasms located in the liver, including a review of outcomes.Seminars in Interventional Radiology 06/2014; 31(2):125-8. DOI:10.1055/s-0034-1373787
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ABSTRACT: Neuroendocrine tumors from gastro-pancreatic origin (GEP-NET) can be responsible for liver metastases. Such metastases can be the dominant part of the disease as well due to the tumor burden itself or the symptoms related to such liver metastases. Intra-arterial therapies are commonly used in liver only or liver dominant disease and encompass transarterial chemoembolization (TACE), transarterial embolization (TAE) and radioembolization. TACE performed with drug emulsified in Lipiodol has been used for the past 20 years with reported overall survival in the range of 3 to 4 years, with objective response up to 75%. Response to TACE is higher when treatment is used as a first line therapy and degree of liver involvement is lower. Benefit of TACE over TAE is unproven in randomized study, but reported in retrospective studies namely in pancreatic NET. Radioembolization provides early interesting results that need to be further evaluated in terms of benefit and toxicity. Radiofrequency ablation allows control of small size and numbered liver metastases, with low invasiveness. Ideal metastases to target with are 1 metastasis less than 5 cm, or 3 metastases less than 3 cm, or a sum of diameter of all metastases below 8 cm. Ablation therapies can be applied in the lung or in the bones when needed, and more invasive surgery should be probably saved for large size metastases. Even if the indication of image guided therapy in the treatment of GEP-NET liver metastases needs to be refined, such therapies allows for manageable invasive set of treatments able to address oligometastatic patients in liver, lung and bones. These treatments applied locally will save the benefit and the toxicity of systemic therapy for more advanced stage of the disease.European Journal of Endocrinology 11/2014; 172(4). DOI:10.1530/EJE-14-0630 · 3.69 Impact Factor