Laparoscopic radiofrequency thermal ablation of neuroendocrine hepatic metastases: Long-term follow-up
Division of Endocrine Surgery, and Liver Tumor Ablation Program, Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH, USA. Surgery
(Impact Factor: 3.38).
12/2010; 148(6):1288-93; discussion 1293. DOI: 10.1016/j.surg.2010.09.014
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.
Available from: ncbi.nlm.nih.gov
- "Author, publication year Number of ablated patients Median followup, months Survival data Comments Karabulut et al., 2011  69 (RFA) 22 Median PFS: 10.5 months Median OS: 73 months No significant overall survival difference between RFA and resection Akyildiz et al., 2010  89 (RFA; 78 with NETs of GI origin, 11 medullary thyroid cancer) 30 Median DFS: 15.6 months Median OS: 72 months Liver tumor volume (>76 cc versus <30 cc, P = .04), symptoms (present versus absent, P = .04), "
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ABSTRACT: In the care of patients with hepatic neuroendocrine metastases, medical oncologists should work in multidisciplinary fashion with surgeons, interventional radiologists, and radiation oncologists to assess the potential utility of liver-directed and systemic therapies. This paper addresses the various roles and evidence basis for cytoreductive surgery, thermal ablation (radiofrequency, microwave, and cryoablation), and embolization (bland embolization (HAE), chemoembolization (HACE), and radioembolization) as liver-directed therapies. Somatostatin analogues, cytotoxic chemotherapy, and the newer agents everolimus and suntinib are discussed as a means for controlling intra- and extrahepatic disease, along with peptide receptor radiotherapy (PRRT). Finally, the experience with orthotopic liver transplant for neuroendocrine tumors is described.
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ABSTRACT: A current share method for paralleling of DC/DC converter with no interconnection is introduced in this paper. This technique uses an AC signal on the output line to realize current share control. It has some merits that other current share methods don't have and is suitable for current share control with great number of module parallel converter system. The parallel converter system using this current share control method is presented, and the basic principle of this current share control method with no control interconnection and the implementation of this method are analyzed in detail. Practical implementation of this method is addressed. The experimental results based on a three-module prototype system show the validity of this approach.
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ABSTRACT: The management of metastatic disease in pancreatic endocrine tumors (PETs) demands a multidisciplinary approach and the cooperation of several medical specialties. The role of surgery is critical, even when a radical excision cannot always be achieved.
A PubMed search of relevant articles published up to February 2011 was performed to identify current information about PET liver metastases regarding diagnosis and management, with an emphasis on surgery.
The early diagnosis of metastases and their accurate localization, most commonly in the liver, is very important. Surgical options include radical excision, and palliative excision to relieve symptoms in case of failure of medical treatment. The goal of the radical excision is to remove the primary tumor bulk and all liver metastases at the same time, but unfortunately it is not feasible in most cases. Palliative excisions include aggressive tumor debulking surgeries in well-differentiated carcinomas, trying to remove at least 90% of the tumor mass, combined with other additional destructive techniques such as hepatic artery embolization or chemoembolization to treat metastases or chemoembolization to relieve symptoms in cases of rapidly growing tumors. The combination of chemoembolization and systemic chemotherapy results in better response and survival rates. Other local destructive techniques include ethanol injection, cryotherapy and radiofrequency ablation.
It seems that the current management of PETs can achieve important improvements, even in advanced cases.
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