Cruoablation of hepatic colorectal metastases

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Abstracts

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number-age of screening tests Abstract PA.163 - Figure 1 Conclusions: VC appears to be a more effective option than FS, and a more convenient choice as compared to CL, especially when avoiding < 5 lll111 polyp reporting. Oncc in life- VC may be the only cost-saving option in average risk-people.

PA.164 COLORECTAL CANCER SCREENING WITH IMMUNOCHEMICAL FAECAL OCCULT BLOOD TEST (FOBT): INTERMEDIATE RESULTS WITH HIGH ACCEPTANCE RATE P, Lecis *, j • S. Mancuso 2 , G, Bertiato 3 , E, Galliani j , F. Soppelsa 2 , R. Mel 2 , R. Schiavon J , A. Quaranta 2 , S. Di Camillo 2 , B. Germana 1 1GastroenterolofiY

Unit, San Martin Hospital, Belhmo uf Preventiun ULSS 1, Bellunu 3 DepartmEnt of Clinical Pathology, San Martin Hospital, Beillmo

2 Depal1lnent

Background and aim: Colorectal C,lUcer sCTeening with fecal occult blood test (f'OnT) has been shown to be effective in reducing mortality from eo1oreetal cancer, Tn our Sanitary District a screening program hased on biennal FOBT was started in march 2005. We deserihe the preliminary results of this screening, particularly the acceptance rate and the appropriateness of colonoscopy in the screening, Material and methods: All residents, aged 50-69, living in six different municipalities were invited hy mail to perform a I-day FOBT, hased on Latex agglutination, Kits were given out by chcmists. Rctumed specimens were cxaminated according to an automatic procedurc provided by the m,lUufacturer, Subjects with positive test were invited to undergo eolonoseopy. People that did not accepted at the first invitalion, were again invited hy mail. Results: Till Novcmber 2005, 12309 subjects were invited to perfoml screening test with FOBT. In four municipalities, after the second invitation, 5037 subjects perfonned test with an acceptance rate of 75%. In two municipalities second invitation is still in progress, 429 of them presented a positive test (5.2%) and 423 were invited to llUdergo Colonoseopy (6 subjects were left out), 392 subjects accepted to perform colonseopy with 92,7% of acceptance, 334 eolonoscopies have

been carried out up to now. The success rate in reaching the caecum was 98%. Conscious sedation has been used in 41 % of colonseopies. At least 216 subjects (70%) with onc adenoma were fOlmd and 121 of them (39%) presented more than one adenoma. 144 of thcm (66.7%) were considered at high risk because presented a villous adenoma or adenoma with high grade disp1asia or adenoma 10 mm or more in diameter or more than two adenomas. Carcinomas were found in 16 subjects (4.8%), 9 male, 7 female, 73% in the distal colon (rectum-sigmoid) and 26% in the proximal colon, 62,5% (10 subjects) were Dukes A (TlNOMO), 25<;() (4 subjects) were Dukes n (T2NOMO-T3NOMO) and 12,59() (2 subjects) were Dukes C (T2NIMO). Conclusions: Colorectal cancer screening hy FOBT is well accepted with good acceptance rate (75%). The appropriateness of colonoscopy (high acceptance rate, success in perfomling complete examination) has determined a high detection rate for carcinoma (1,9%0) and for high risk adenomas (17,4%0) These preliminary results suggest the efficacy of the colorectal cancer screening with immlUlOchemical FOB'l'.

PA.165 CRYOABLATION OF HEPATIC COLORECTAL METASTASES A.M, Paganini j, 1. Samari j, M, Guerrieri j, G, D'Ambrosio 2 ,A. Dc Sanctis 1 , L. Solinas 2, G, Lezoche 2, E. Lezoche 2 j Department of General Surfiery, University ofAncona, Ancona 2Cliniea Chirurxiea 11, Univasitil ili Ruma "La Sapienza", Ruma

Background and aim: Liver resection is the standard treatmcnt of secondary hepatic tumors, with 57% 3-years and 40% 5-years survival, hUl only 10-20% of patienL~ are e1igihle for a curative reseelion. Patients with unresectable tumors undergo chemotherapy alone with 16-19 months mcdian survival. Cryosurgical ablation (CSA) may improve thc survival rate in unresectable patients, We prospectively studied the short and long term results of CSA as an adjunct to systemic chemotherapy for the treatment of hepatic colo-rectal tumors Material and methods: Between February 1996 and February 2005, 64 patients (35 males, 29 females, mcan age 58,8 years, rangc 30-79

S114

Abstracts

years) underwent CSA. Thirteen patients with up to 3 lesions were treated laparoscopically and 51 with more than 3 lesions were treated with open CSA. In 59 cases (group A) CSA was obtained with the CMS AccuProbe System and 5-8 mm probes (Rockville, MD, USA), while in the last 5 patients (group B) the Cryo 6 Erbe System with 3 mm probes (Tuebingen, Germany) was employed. Results: Intra and postoperative bleeding rates, as well as the morbidity rate, were lower in group B. Patients with up to 3 lesions had an overall survival rate of 77% at a mean follow-up of 86.9 months (range: 52.2-106.2 months), with 30% of patients who are disease-free. Patients with more than 3 lesions had an overall survival rate of 31% at a mean follow-up of 60.7 months (range: 6.8-105.5 months), with 50% of patients who are disease-free. No local recurrence was observed. Conclusions: Laparoscopic CSA together with systemic chemotherapy in patients with up to 3 hepatic lesions is associated with survival rates which are similar to those after hepatic resectiou. Iu patieuts with a larger tumor burden CSA with chemotherapy improves survival as compared to historical controls undergoing chemotherapy alone.

PA.166 INTERSTITIAL LASER PHOTOCOAGULATION OF HEPATOCELLULAR CARCINOMA ON CIRRHOSIS IN CONSCIOUS PATIENT: A FEASIBILITY STUDY L. Tarantino .,1, S. Del Prete 1 , A. Piscopo 2, V. Nocera 3, F. Montanaro 4, LF.M. Sordelli 5, P. Sperlongano 5 lInterventionnl US Unit - SGiovanni di Dio Hospital - ASINA3, Frattamaggiore (NA) 2Anestesiologia - S Giovanni di Dio Hospital - ASINA3, Frattamaggiore (NA) 3 Radiologia - S Giovanni di Dio Hospital - ASINA3, Frattamaggiore (NA) 4Gastroenterology Unit - SGiovanni di Dio Hospital - ASINA3, Frattamaggiore (NA) 5V Division ofSurgery - II University ofNaples, Naples

Background and aim: Percutaneous Laser Photocoagulation under ultrasound guidance (ILP) of Hepatocellular carcinoma (HCC)is usually performed with deep sedatiou or general anhestesia. These procedures eutail depressed consciousness of the patient with risks of impaired airway and need for anhestesiologist' presence during the procedure Liver parenchyma receives autonomic innervation. No sensory fibers are present in the liver parenchyma. Considered the above mentioned issues, we evaluated if ILP of HCC can be safely and effectively perfomed without general anesthesia nor deep sedation. Material and methods: 30 cirrhotic patients with 33 nodules of HCC (0 1.2 - 4.6 em; mean:2.2) underwent ILP. We used as laser source, a continuous-wave Nd: YAG laser operating at 1.064 J.lm (Deka-Me1a, Florence, Italy). After inserting from 2 to 4 fibers per nodule, Laser energy was delivered with an output power of 4 Wand in order to attain energy delivered of 1,600 J per fiber. All procedures were performed with only local anesthesia an on Day-Hospital basis. Patients were selected according the following parameter: a) 1 nodule with diameter < 5 em or up to 3 nodules with diameter < 3 em; b) Intraparechymal location (alleast 1 em far off the liver capsule or the galbladder or the hepatic hilum). Necrosis of the nodnles was evaluated with triphasic contrast-enhanced CT Results: Side effects observed during the treatment (light to moderate pain in 8 patients and retching in 3 patients) were successfully treated with i.v. pain-killer and antiemetic drugs. Only in 1 case the procedure was stopped, because of the pain, before the scheduled time. No complication occnrred. Post-treatment CT showed complete necrosis in 27/33 nodnles (81%) and partial necrosis in 6 nodnles Conclusions: ILP of HCC withont general anesthesia is feasible and also cost-Effective. Infact, it avoids the need for operatory room, anes-

thetics' administration and the presence of the anesthesiologist and can be performed on Day-Hospital basis.

PA.167 NON· SURGICAL HEPATOCELLULAR CARCINOMA(HCC): COMPLICATIONS AFTER PERCUTANEOUS ETHANOL INJECTION (PEl), LASER THERMAL ABLATION (LTA) AND RADIO-FREQUENCY ABLATION (RFA). A SINGLE HOSPITAL CENTRE EXPERIENCE F. Magnolfi ., F. Caneschi, R. Monterubbianesi

Ospedale S Donnto, Arezzo

Background and aim: To evaluate the mortality and complications cansed by PEl, RFA and LTA, simnltaneously used in the same period of time, in a single Centre, by the same operators with an equal level of experience in percutaneous ablation treatments of non-operable HCC. Material and methods: 85 consecutive patients(MIF:60125; meanage:72 yr; Child A1B:68/17; early st. 64, intermediate st. 16 and advanced 5, according to EASL classification)with 168 HCCs(range 780mm)nnderwent percntaneous ablation treatments, from March 1997 to December 2004.114 nodules were treated by PEl in 807 sessions.4l nodules were treated by LTA in 64 sessions using a neodimium-YAG generator equipped with a "beam splitter" utilizing from 1 to 4 fibres. 18 nodules were treated by RFA in 24 sessions using expandibles or cold electrode needles. 895 percntaneons treatement sessions were performed during all the study. Results: Two mortal complications occurred: LTA caused colonic intestinal wall burn while RFA determined the breakage of a subglissonian HCC. 4 cases of major complications were reported, all after LTA but 1 after RFA: LTA caused a burn of the abdominal wall, an acnte cholecystitis and a declassing from Child class B to class C. RFA cansed a spontaneons bacterial peritonitis. 16 were the minor complications occurred (9 complications after LTA and 7 caused by PEl). LTA produced a mild hemoperitoneum(1), small subcapsular haematoma(3), mild perihepatic effusion(2), pericholecystic hemorrhage (1), necrosis of non-neoplastic cyrrotic area of the liver (1), necrosis of perirenal fat (1). PEl caused the following complications: biliary duct stenosis(1), subhepatic effusion(1), mnscnlar haematoma of the abdominal wall (1), acute cholecystitis(1), acute cholangytis (1), liver abscess (1), mild haemoperitonenm (1). In total the mortality rate was 2.3%, the major complications rate was 4.7% and the minor complications rate 18.8%. Conclusions: A high rate of mortality occurred when patients underwent to RFA and LTA, considering the number of patients treated and the number of sessions carried ont.The 807 sessions of PEl have never cansed deaths or major complications. Therefore we consider PEl the safer way to treat HCC lesions rather than LTA or RFA, performed by the same operators with the same experience of percutaneous ablation techniques.

PA.168 TAILORED THERAPY OF HEPATOCELLULAR CARCINOMA BY PERCUTANEOUS ETHANOL INJECTION(PEI), RADIOFREQUENCY(RFA), LASER(LTA), TRANSARTERIAL CHEMOEMBO LIZATION(TACE): TREATMENT EFFICACY AND PREDICTORS OF SURVIVAL IN THE EXPERIENCE OF A SINGLE HOSPITAL CENTRE F. Magnolfi ., F. Caneschi, R. Monterubbianesi

Ospedale S Donnto, Arezzo

Background and aim: To evaluate the treatment efficacy and the longterm survival of patients with early and intermediate-advanced HCC (EASL classification) treated in a single hospital centre by PEl, LTA, RFA and TACE, simultaneously available in the same period of time by