title: Computer planned, image-guided combined resection and ablation for bilobar colorectal liver metastases.
abstract: For patients with extensive bilobar colorectal liver metastases (CRLM), initial surgery may not be feasible and a multimodal approach including microwave ablation (MWA) provides the only chance for prolonged survival. Intraoperative navigation systems may improve the accuracy of ablation and surgical resection of so-called "vanishing lesions", ultimately improving patient outcome. Clinical application of intraoperative navigated liver surgery is illustrated in a patient undergoing combined resection/MWA for multiple, synchronous, bilobar CRLM. Regular follow-up with computed tomography (CT) allowed for temporal development of the ablation zones. Of the ten lesions detected in a preoperative CT scan, the largest lesion was resected and the others were ablated using an intraoperative navigation system. Twelve months post-surgery a new lesion (Seg IVa) was detected and treated by trans-arterial embolization. Nineteen months post-surgery new liver and lung metastases were detected and a palliative chemotherapy started. The patient passed away four years after initial diagnosis. For patients with extensive CRLM not treatable by standard surgery, navigated MWA/resection may provide excellent tumor control, improving longer-term survival. Intraoperative navigation systems provide precise, real-time information to the surgeon, aiding the decision-making process and substantially improving the accuracy of both ablation and resection. Regular follow-ups including 3D modeling allow for early discrimination between ablation zones and recurrent tumor lesions.
authors.affiliation: Vanessa M Banz, Matthias Baechtold, Daniel Inderbitzin, Daniel Candinas, Department of Visceral Surgery and Medicine, Inselspital, Berne University Hospital and University of Berne, CH-3010 Berne, Switzerland.
authors.forename: Vanessa M
authors.initials: VM
authors.lastname: Banz
authors.affiliation: Vanessa M Banz, Matthias Baechtold, Daniel Inderbitzin, Daniel Candinas, Department of Visceral Surgery and Medicine, Inselspital, Berne University Hospital and University of Berne, CH-3010 Berne, Switzerland.
authors.forename: Matthias
authors.initials: M
authors.lastname: Baechtold
authors.affiliation: Vanessa M Banz, Matthias Baechtold, Daniel Inderbitzin, Daniel Candinas, Department of Visceral Surgery and Medicine, Inselspital, Berne University Hospital and University of Berne, CH-3010 Berne, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Weber
authors.affiliation: Vanessa M Banz, Matthias Baechtold, Daniel Inderbitzin, Daniel Candinas, Department of Visceral Surgery and Medicine, Inselspital, Berne University Hospital and University of Berne, CH-3010 Berne, Switzerland.
authors.forename: Matthias
authors.initials: M
authors.lastname: Peterhans
authors.affiliation: Vanessa M Banz, Matthias Baechtold, Daniel Inderbitzin, Daniel Candinas, Department of Visceral Surgery and Medicine, Inselspital, Berne University Hospital and University of Berne, CH-3010 Berne, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Inderbitzin
authors.affiliation: Vanessa M Banz, Matthias Baechtold, Daniel Inderbitzin, Daniel Candinas, Department of Visceral Surgery and Medicine, Inselspital, Berne University Hospital and University of Berne, CH-3010 Berne, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Candinas
mesh_terms: D055011:Ablation Techniques / Q000379:methods*; D015179:Colorectal Neoplasms / Q000473:pathology*; D018450:Disease Progression; D017809:Fatal Outcome; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery*; D008872:Microwaves / Q000627:therapeutic use*; D008875:Middle Aged; D010166:Palliative Care; D011237:Predictive Value of Tests; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Colorectal liver metastases; Computer navigation; Image-guidance; Microwave ablation; Tumor