Öz

Amaç: Çalışmamızda karaciğer metastazlarında ultrason eşliğinde yapılan mikrodalga ablasyon tedavisi sonrası gelişen lokal nüksün karaciğer kapsülü ve ablasyon traktı ile ilgili özelliklerinin değerlendirlmesi amaçlanmıştır. Yöntemler: Şubat 2016 ile Aralık 2019 tarihleri arasında mevcut karaciğer metastazına US rehberliğinde perkutan mikrodalga abalasyon tedavisi yapılan 101 olgu retrospektif olarak değerlendirildi. Toplam 32 lokal nükse sahip ablate lezyonu bulunan 19 hasta çalışmaya dahil edildi. Metastazların histopatolojik tipleri, ablasyon öncesi özellikleri ve ablasyon işlemine ait bilgiler not edildi. Tümörün boyutları ve tümör ile karaciğer kapsülü arasındaki en kısa mesafe ölçüldü. Lokal nüksün karaciğer kapsülüne ve ablasyon tarktına göre tarafı ve yerleşimi ile şekil özellikleri değerlendirildi. Bulgular: Ortanca lokal nükssüresi 8.46±4.54 ay (3-20 aralığında) olarak bulundu. Hasta ve lezyon bağımlı lokal nüks oranları sırasıyla 19% ve 20% idi. Parankim içi yerleşimli lezyonlara ait lokal nükslerin tümü ablasyon traktının ucu ya da yanında yerleşimli olarak bulundu ve bu ilişki istatistiksel olarak anlamlıydı (p=0.035). Damar yakınlığı ile lokal nüksün şekli ve lokal nüksün tarafı ile şekli arasında istatistiksel olarak anlamlı ilişki saptanmadı (sırasıyla p=0.704 ve 0.683). Sonuç: Çalışmamızda parankimal yerleşimli lezyonlardan gelişen lokal rekürrensin hepsinin ablasyon traktının uç ve yan kesimlerinden geliştiği ortaya konulmuştur. Ayrıca lokal rekürrensin karaciğer kapsülü ve ablasyon traktı ile ilişkili bir takım özellikleri ve bu bulguların birbiri ile ilgili ilişkileri ortaya konuldu.

Anahtar Kelimeler

• Lokal rekurrens
• mikrodalga ablasyon
• ablasyon trakt
• karaciğer metastazları
• karaciğer kapsülü

Capsule and Ablation Tract Related Features of Local Recurrence in Ultrasound Guided Microwave Ablation of Liver Metastases

Abstract

Aim: To evaluate the capsule and ablation tract related features of local recurrence after ultrasound (US) guided percutaneous microwave ablation (MWA) of the liver metastases independently. Methods: Between February 2016 and December 2019, 101 patients with US-guided percutaneous MWA of the liver metastases were analyzed. Nineteen patients having thirty-two ablated lesions with local recurrence (LR) were included in the study. Histopathologic type of tumor, preablative features of the lesions and the ablation procedure data were noted. Tumor size, the closest distance between the lesion and the liver capsule was measured. The site of LR related to the liver capsule and related to ablation tract and the shape of the LR were noted Results: The median time of LR was 8.46±4.54 months (range, 3-20). The patient (n=19) and the ablated lesion (n=32) depended LR rates were 19% and 20% respectively. All LR of the parenchymal localized metastatic lesions originated from either tip or the side of the ablation tract and this relationship was found as statistically significant (p=0.035). no statistically significant relationship was found between vessel closeness and shape of LR (p=0,704) and between the site and the shape of LR (p=0.683). Conclusion: We defined some features of LR related to the ablation tract and liver capsule independently such as the relation between the recurrence and the blood vessel proximity, side of the LR throughout the ablation tract and its relation with the liver capsule.

Keywords

• Local recurrence
• ultrasound
• Microwave ablation
• Ablation tract
• Liver metastasis
• Liver capsule

Kaynakça

1. 1) Chow FCL, Chok KSH. Colorectal liver metastases: An update on multidisciplinary approach. World J Hepatol 2019; 11(2): 150-172.
2. 2) Silverberg E, Boring CC, Squires TS. Cancer statistics 1990. Cancer Clin 1990; 40:9–26.
3. 3) Jessup JM, Mc Ginnis LS, Steele GD et al. National Cancer Data Base. Report on colon cancer. Cancer 1996; 78: 918–26.
4. 4) Meijerink MR, Puijk RS, VanTilborg AAJM et al. Radiofrequency and microwave ablation compared to systemic chemotherapy and to partial hepatectomy in thetreatment of colorectal liver metastases: a systematic review and meta-analysis. Cardiovasc Intervent Radiol 41: 1189–1204.
5. 5) Minagawa M, Makuuchi M, Torzilli G et al. Extension of the frontiers of surgical indications in thetreatment of liver metastases from colorectal cancer: long-term results. Ann Surg 231:487–499.
6. 6) Geoghegan JG, Scheele J. Treatment of colorectal liver metastases. Br J Surg. 1999; 86:158–169.
7. 7) Noori SS, Gonsalves CF, Shaw CM. Metastatic liver disease: Indications for locoregional therapy and supporting data. Semin Intervent Radiol 2017;34:145–166.
8. 8) Mulier S, Ni Y, Jamart J et al. Local recurrence after hepatic radiofrequency coagulation: multivariate meta-analysis and review of contributing factors. Ann Surg 242:158–171.

9. 9) Siperstein A, Garland A, Engle K et al. Local recurrence after laparoscopic radiofrequency thermal ablation of hepatic tumors. Ann Surg Oncol 7:106–113.
10. 10) Leung U, Kuk D, D’Angelica MI et al. Long-term outcomes following microwave ablation for liver malignancies. Br J Surg. 2015 January; 102(1): 85–91.
11. 11) Komorizono Y, Oketani M, Sako K et al. Risk factors for local recurrence of small hepatocellular carcinoma tumors after a single session, single application of percutaneous radiofrequency ablation. Cancer 2003;97: 1253– 62.
12. 12) Shady W, Petre EN, Gonen M et al. Percutaneous Radiofrequency Ablation of Colorectal Cancer Liver Metastases: Factors Affecting Outcomes — A 10-year Experience at a Single Center. Radiology 2016; 278:601–611.
13. 13) Sartori S, Tombesi P, Macario F et al. Subcapsular Liver Tumors Treated with Percutaneous Radiofrequency Ablation: A Prospective Comparison with Nonsubcapsular Liver Tumors for Safety and Effectiveness. Radiology 2008; 248:670 –679.
14. 14) Curley SA, Izzo F, Delrio P et al. Radiofrequency ablation of unresectable primary and metastatic hepatic malignancies: results in 123 patients. Ann Surg 1999; 230:1–8.
15. 15) Xu C, Li L, Xu W et al. Ultrasound-guided percutaneous microwave ablation versus surgical resection for recurrent intrahepatic cholangiocarcinoma: intermediate-term results, International Journal of Hyperthermia 2019, 36:1, 350-357.
16. 16) Xu Z, Yang Z, Pan J, Hu Y. Individualized laparoscopic B-ultrasound-guided microwave ablation for multifocal primary liver cancer. Videosurgery Miniinv 2018; 13 (1): 9–16.
17. 17) Corte AD, Ratti F, Monfardini L. Comparison between percutaneous and laparoscopic microwave ablation of hepatocellular carcinoma, International Journal of Hyperthermia 2020; 37:1:542-548.
18. 18) Lorentzen T, Skjoldbye BO, Nolsoe CP. Microwave Ablation of Liver Metastases Guided by Contrast-Enhanced Ultrasound: Experience with 125 Metastases in 39 Patients. Ultraschall in Med 2011; 32: 492–496.
19. 19) Vogl TJ, Nour-Eldin A, Hammerstingl RM et al. Microwave Ablation (MWA): Basics, Technique and Results in Primary and Metastatic Liver Neoplasms – Review Article. Fortschr Röntgenstr 2017; 189: 1055 – 1066.
20. 20) An C, Cheng Z, Yu X et al. Ultrasound-guided percutaneous microwave ablation of hepatocellular carcinoma in challenging locations: oncologic outcomes and advanced assistive technology, International Journal of Hyperthermia 2020;37:1, 89-100.
21. 21) Gilbert P, Arrington D, Yamada R, Hannegan C, Anderson MB, Selby Jr B, Guimaraes M. Protective techniques in image-guided percutaneous hepatic ablations. Intervent Oncol 360. 2016;4(5):E75-E85.
22. 22) Komorizono Y, Oketani M, Sako K, et al. Risk factors for local recurrence of small hepatocellular carcinoma tumors after a single session, single application of percutaneous radiofrequency ablation. Cancer 2003;97(5):1253–1262.
23. 23) Hori T, Nagata K, Hasuike S, et al. Risk factors for the local recurrence of hepatocellular carcinoma after a single session of percutaneous radiofrequency ablation. J Gastroenterol 2003;38(10):977–981.
24. 24) Choi D, Lim HK, Kim MJ, et al. Therapeutic efficacy and safety of percutaneous radiofrequency ablation of hepatocellular carcinoma abutting the gastrointestinal tract. AJR Am J Roentgenol 2004;183(5):1417–1424.
25. 25) Poon RT, Ng KK, Lam CM et al. Radiofrequency ablation for subcapsular hepatocellular carcinoma. Ann Surg Oncol 2004;11(3):281–289.
26. 26) Lu DS, Raman SS, Limanond P et al. Influence of large peritumoral vessels on outcome of radiofrequency ablation of liver tumors. J Vasc Interv Radiol 2003; 14:1267–74.
27. 27) Wright AS, Sampson LA, Warner TF et al. Radiofrequency versus microwave ablation in a hepatic porcine model. Radiology. 2005;236(1): 132–139.
28. 28) Brannan JD, Ladtkow CM. Modeling bimodal vessel effects on radio and microwave frequency ablation zones. Conf Proc IEEE Eng Med Biol Soc. 2009; 5989–5992
29. 29) Dodd GD, Dodd NA, Lanctot AC et al. Effect of variation of portal venous blood flow on radiofrequency and microwave ablations in a blood-perfused bovine liver model. Radiology. 2013;267(1): 129–136.