A New Technique of Radiofrequency-assisted Ultrasound-guided Needle-localized Laparoscopic Resection of Disappearing Colorectal Liver Metastases.
The management of disappearing colorectal liver metastases in the postadjuvant chemotherapy setting is challenging. We describe a novel technique that facilitates laparoscopic resection of disappearing metastatic liver lesions with great precision. Details of this new technique are described in 2 patients with colorectal cancer synchronously metastatic to the liver. Both patients had small indistinct intraparenchymal liver lesions after adjuvant chemotherapy. A video displays the steps of the procedure. Both patients presented with colorectal cancer with synchronous liver metastasis. They received FOLFOX regimen after resection of their primary. They both responded to adjuvant chemotherapy. On repeat posttreatment imaging, the liver lesions became smaller and indistinct. With laparoscopic ultrasound, subtle parenchymal heterogeneities were identified. The lesions were initially ablated with a wide radiofrequency ablation zone. Then, without removing the needle, the prongs were deployed to the borders of the parenchymal heterogeneity. Using an ultrasonic vessel sealer, the lesions were resected. Final pathology identified 1 viable focus of cancer in each patient. Both patients were discharged home uneventfully on their second postoperative day. There were no complications. We have described a novel technique that could facilitate precise resection of intraparenchymal small indistinct or disappearing liver metastases of colorectal origin. This option should be kept within the armamentarium of the laparoscopic liver surgeon managing patients with malignant liver tumors.
*Department of General Surgery, Cleveland Clinic, Cleveland, OH †Division of Surgical Oncology, Texas Tech University Health Sciences Center, Amarillo, TX.
Hakan
H
Yigitbas
Pinar
P
Yazici
Halit E
HE
Taskin
Alexis K
AK
Okoh
Cem
C
Dural
Nail
N
Aydin
Eren
E
Berber
D000230:Adenocarcinoma / Q000188:drug therapy / Q000556:secondary / Q000601:surgery*; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D000068258:Bevacizumab / Q000008:administration & dosage; D017115:Catheter Ablation / Q000379:methods*; D002430:Cecal Neoplasms; D017024:Chemotherapy, Adjuvant / Q000379:methods; D015179:Colorectal Neoplasms; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D002955:Leucovorin / Q000008:administration & dosage; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D018084:Ultrasonography, Interventional / Q000379:methods
D009944:Organoplatinum Compounds; D000068258:Bevacizumab; D002955:Leucovorin; D005472:Fluorouracil