title: Planned Treatment of Advanced Metastatic Disease with Completion Ablation After Hepatic Resection.
abstract: 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]").
  
  
  
  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).
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1471, Houston, TX, 77030, USA. bcodisio@mdanderson.org.
authors.forename: Bruno C
authors.initials: BC
authors.lastname: Odisio
authors.affiliation: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Suguru
authors.initials: S
authors.lastname: Yamashita
authors.affiliation: Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1471, Houston, TX, 77030, USA.
authors.forename: Livia
authors.initials: L
authors.lastname: Frota
authors.affiliation: Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1471, Houston, TX, 77030, USA.
authors.forename: Steven Y
authors.initials: SY
authors.lastname: Huang
authors.affiliation: Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Scott E
authors.initials: SE
authors.lastname: Kopetz
authors.affiliation: Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1471, Houston, TX, 77030, USA.
authors.forename: Kamran
authors.initials: K
authors.lastname: Ahrar
authors.affiliation: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Yun Shin
authors.initials: YS
authors.lastname: Chun
authors.affiliation: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Aloia
authors.affiliation: Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1471, Houston, TX, 77030, USA.
authors.forename: Marshall E
authors.initials: ME
authors.lastname: Hicks
authors.affiliation: Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1471, Houston, TX, 77030, USA.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Jean-Nicolas
authors.initials: JN
authors.lastname: Vauthey
mesh_terms: D055011:Ablation Techniques; D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D008297:Male; D059146:Metastasectomy / Q000379:methods*; D008875:Middle Aged; D010347:Patient Care Planning; D018579:Patient Selection; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Advanced metastatic disease; Complete ablation; Image-guided percutaneous ablation