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Early recurrence of HCC after curative hepatectomy
576
Journal of Gastrointestinal Surgery
Abstracts
Switching Controller consistently resulted in ablation lesions with larger Dmin, SAmax and volume than ablations with the standard cool tip cluster. Furthermore, the Pringle maneuver allowed for the creation of an equally sized lesion in half of the time (Table 1).
Table 1. Cluster vs Switcher Multiprobe Ablation Outcomes
Cluster Switcher P value
Dmin (mm)
SAmax (cm2)
Volume (ml)
40.3 51.4 ⬍0.0001
16.0 22.4 0.0002
36.9 66.1 ⬍0.0001
180 SIMULTANEOUS RESECTION OF A DUODENAL VILLOUS ADENOMA, HEPATOCELLULAR CARCINOMA, AND COLON CARCINOMA Steven Brooks, MS, Reza F. Saidi, MD, Alisdair Mckendrick, MD, Michael J. Jacobs, MD, Providence Hospital and Medical Centers, Southfield, MI Synchronous neoplasms of the gastrointestinal tract are uncommon. The presence of multiple distinctly different carcinomas is rare and often associated with an underlying syndrome or genetic aberrancy. Herein, we present a case of three primary neoplasms that included hepatocellular carcinoma, duodenal villous adenoma, and metachronous colon carcinoma. An 83-year-old male who was a former professional athlete presented for acute blood loss anemia. The past medical and surgical history were significant for a right hemicolectomy 20 years prior secondary to carcinoma. Endoscopic workup and preoperative imaging demonstrated a villous adenoma of the second portion of the duodenum, metachronous carcinoma of the transverse colon, and a liver mass. The patient underwent simultaneous resection of the villous adenoma, transverse colon, and segment V liver mass. The liver mass pathology was consistent with a 4.5-cm well-differentiated hepatocellular carcinoma. The transverse colon pathology revealed a moderately differentiated adenocarcinoma that measured 4 × 5 × 1 cm. The duodenal lesion was a large villous adenoma from the distal second portion of the duodenum that did not have invasive disease. The patient had an R0 resection of the malignant lesions and was discharged on postoperative day six without morbidity.
181 MULTIMODAL CYTOREDUCTION RESULTS IN SYMPTOM ALLEVIATION OF PATIENTS WITH ADVANCED CARCINOID LIVER METASTASES Shalini Kanneganti, MD, Klaus Thaler, MD, Paul Hansen, MD, Minimally Invasive Surgery/Legacy Health System, Portland, OR The objective of our study is to outline the efficacy of multimodal hepatic cytoreduction in the amelioration of symptoms in patients with advanced hepatic carcinoid metastases. Retrospective analysis of data collected on consecutive patients with metastatic carcinoid tumor to liver between October 1996 and October 2004. All the patients underwent hepatic cytoreduction with chemoembolization, resection, and/or radiofrequency ablation. Fifteen patients, mean age 61 (SD 11) years, underwent cytoreduction; 12 (80%) of the patients had extensive bilobular disease and 3 (20%) had solitary lesions. The average maximum tumor size was 4.04 cm (SD 3). 12 patients (80%) had specific preoperative carcinoid related symptoms and 10 (66.6%) had extrahepatic metastatic disease at the time of surgery. 13 patients
underwent a palliative debulking procedure. Hepatic cytoreduction included laparoscopic radiofrequency ablation on 10 patients, ethanol injections on 9, chemoembolization on 7, laparoscopic resections on 2, open resection on 1, and a multimodal approach was used on 9. At a postoperative mean follow-up after 29 months (SD 22.1), 6 patients (40%) had stable disease, 8 (53.3%) had progression of disease [hepatic only n ⫽ 2 (25%), hepatic and extrahepatic n ⫽ 3 (37.5%)] and 1 (6.6%) had no disease. Deaths occurred in 4 patients of which 2 were due to progression of disease. The mean and median symptom relief period was for 15 and 12 months, respectively. Aggressive cytoreductive hepatic therapy in patients with advanced metastatic disease is efficient in achieving symptom relief and disease control. The timing of combined treatment modalities and its role in prolonging survival warrant future studies.
182 EARLY RECURRENCE OF HCC AFTER CURATIVE HEPATECTOMY Yuki Kimura, Masamichi Moriguchi, Kazuto Inoue, Tokio Higaki, Tadatoshi Takayama, Nihon University, Toyko, Japan Hepatectomy has been established as major treatment of hepatocellular carcinoma (HCC). However, it is highly recurrence rate after curative resection: 5-year cumulative recurrence rates have been reported 80∼100%. The purpose of this study, we have evaluated prognostic factors in patients with recurrnce after undergoing curative resection of HCC, especially early type (within 6 months).
183 MICROWAVE HEPATIC ABLATION LEADS TO A MORE EFFICIENT AND EFFECTIVE HEPATIC ABLATION Robert C. Martin, Charles Scoggins, MD, Kelly M. McMasters, MD, PhD, University of Louisville, Louisville, KY Hepatic tumor ablation has become an accepted and effective method of controlling both primary and secondary malignancies in combination with surgery or as the primary therapy. Radiofrequency ablation (RF) has been demonstrated to have a lower complication rate than cryoablation, however, the recurrence rate has been highly variable, from 9% to 50% depending on technique. Recent evidence has demonstrated that RF ablation may lose its effectiveness at the peripheral portion of the lesion. In addition tumors near blood vessels may be protected by the cooling effect of blood flow. Microwave ablation has been demonstrated to effectively treatment of hepatic tumors in multiple treat and resect studies. This study represents the first report of microwave ablation as the primary therapy in patients with hepatic malignancies. a prospective multi-institutional trial and retrospective study of microwave ablation of hepatic tumors from 1/2004 until 10/2004 was reviewed. A standard bracketed technique of placing multiple (maximum 3) probes around the periphery of the tumor was utilized. In all cases multiple ablations of hepatic lesions was performed simultaneously. Fifty-eight hepatic tumors were ablated in 18 patients (7 colorectal, 11 noncolorectal). The median tumor number was 3 (range 1-13) with a median size of 3 cm (range 1.5 to 4.0 cm). Multiple types of microwave probes (Surgical straight, Atom, and laparoscopic) were utilized depending on location and size. Nine patients underwent additional procedures including partial hepatectomies, colectomy, and gastrectomy. Total median ablation time was 10 minutes (range 5 to 22.5). There were no perioperative mortalities, with perioperative morbidity occurring in 5 patients, none of them related to hepatic ablation. After a median follow-up of 6 months there have been no ablation recurrences. Microwave ablation represents a faster and safer way to perform hepatic ablations in patients. The ability to perform bracketed ablations in tumors that are not perfectly spherical
Journal of Gastrointestinal Surgery
Abstracts
Switching Controller consistently resulted in ablation lesions with larger Dmin, SAmax and volume than ablations with the standard cool tip cluster. Furthermore, the Pringle maneuver allowed for the creation of an equally sized lesion in half of the time (Table 1).
Table 1. Cluster vs Switcher Multiprobe Ablation Outcomes
Cluster Switcher P value
Dmin (mm)
SAmax (cm2)
Volume (ml)
40.3 51.4 ⬍0.0001
16.0 22.4 0.0002
36.9 66.1 ⬍0.0001
180 SIMULTANEOUS RESECTION OF A DUODENAL VILLOUS ADENOMA, HEPATOCELLULAR CARCINOMA, AND COLON CARCINOMA Steven Brooks, MS, Reza F. Saidi, MD, Alisdair Mckendrick, MD, Michael J. Jacobs, MD, Providence Hospital and Medical Centers, Southfield, MI Synchronous neoplasms of the gastrointestinal tract are uncommon. The presence of multiple distinctly different carcinomas is rare and often associated with an underlying syndrome or genetic aberrancy. Herein, we present a case of three primary neoplasms that included hepatocellular carcinoma, duodenal villous adenoma, and metachronous colon carcinoma. An 83-year-old male who was a former professional athlete presented for acute blood loss anemia. The past medical and surgical history were significant for a right hemicolectomy 20 years prior secondary to carcinoma. Endoscopic workup and preoperative imaging demonstrated a villous adenoma of the second portion of the duodenum, metachronous carcinoma of the transverse colon, and a liver mass. The patient underwent simultaneous resection of the villous adenoma, transverse colon, and segment V liver mass. The liver mass pathology was consistent with a 4.5-cm well-differentiated hepatocellular carcinoma. The transverse colon pathology revealed a moderately differentiated adenocarcinoma that measured 4 × 5 × 1 cm. The duodenal lesion was a large villous adenoma from the distal second portion of the duodenum that did not have invasive disease. The patient had an R0 resection of the malignant lesions and was discharged on postoperative day six without morbidity.
181 MULTIMODAL CYTOREDUCTION RESULTS IN SYMPTOM ALLEVIATION OF PATIENTS WITH ADVANCED CARCINOID LIVER METASTASES Shalini Kanneganti, MD, Klaus Thaler, MD, Paul Hansen, MD, Minimally Invasive Surgery/Legacy Health System, Portland, OR The objective of our study is to outline the efficacy of multimodal hepatic cytoreduction in the amelioration of symptoms in patients with advanced hepatic carcinoid metastases. Retrospective analysis of data collected on consecutive patients with metastatic carcinoid tumor to liver between October 1996 and October 2004. All the patients underwent hepatic cytoreduction with chemoembolization, resection, and/or radiofrequency ablation. Fifteen patients, mean age 61 (SD 11) years, underwent cytoreduction; 12 (80%) of the patients had extensive bilobular disease and 3 (20%) had solitary lesions. The average maximum tumor size was 4.04 cm (SD 3). 12 patients (80%) had specific preoperative carcinoid related symptoms and 10 (66.6%) had extrahepatic metastatic disease at the time of surgery. 13 patients
underwent a palliative debulking procedure. Hepatic cytoreduction included laparoscopic radiofrequency ablation on 10 patients, ethanol injections on 9, chemoembolization on 7, laparoscopic resections on 2, open resection on 1, and a multimodal approach was used on 9. At a postoperative mean follow-up after 29 months (SD 22.1), 6 patients (40%) had stable disease, 8 (53.3%) had progression of disease [hepatic only n ⫽ 2 (25%), hepatic and extrahepatic n ⫽ 3 (37.5%)] and 1 (6.6%) had no disease. Deaths occurred in 4 patients of which 2 were due to progression of disease. The mean and median symptom relief period was for 15 and 12 months, respectively. Aggressive cytoreductive hepatic therapy in patients with advanced metastatic disease is efficient in achieving symptom relief and disease control. The timing of combined treatment modalities and its role in prolonging survival warrant future studies.
182 EARLY RECURRENCE OF HCC AFTER CURATIVE HEPATECTOMY Yuki Kimura, Masamichi Moriguchi, Kazuto Inoue, Tokio Higaki, Tadatoshi Takayama, Nihon University, Toyko, Japan Hepatectomy has been established as major treatment of hepatocellular carcinoma (HCC). However, it is highly recurrence rate after curative resection: 5-year cumulative recurrence rates have been reported 80∼100%. The purpose of this study, we have evaluated prognostic factors in patients with recurrnce after undergoing curative resection of HCC, especially early type (within 6 months).
183 MICROWAVE HEPATIC ABLATION LEADS TO A MORE EFFICIENT AND EFFECTIVE HEPATIC ABLATION Robert C. Martin, Charles Scoggins, MD, Kelly M. McMasters, MD, PhD, University of Louisville, Louisville, KY Hepatic tumor ablation has become an accepted and effective method of controlling both primary and secondary malignancies in combination with surgery or as the primary therapy. Radiofrequency ablation (RF) has been demonstrated to have a lower complication rate than cryoablation, however, the recurrence rate has been highly variable, from 9% to 50% depending on technique. Recent evidence has demonstrated that RF ablation may lose its effectiveness at the peripheral portion of the lesion. In addition tumors near blood vessels may be protected by the cooling effect of blood flow. Microwave ablation has been demonstrated to effectively treatment of hepatic tumors in multiple treat and resect studies. This study represents the first report of microwave ablation as the primary therapy in patients with hepatic malignancies. a prospective multi-institutional trial and retrospective study of microwave ablation of hepatic tumors from 1/2004 until 10/2004 was reviewed. A standard bracketed technique of placing multiple (maximum 3) probes around the periphery of the tumor was utilized. In all cases multiple ablations of hepatic lesions was performed simultaneously. Fifty-eight hepatic tumors were ablated in 18 patients (7 colorectal, 11 noncolorectal). The median tumor number was 3 (range 1-13) with a median size of 3 cm (range 1.5 to 4.0 cm). Multiple types of microwave probes (Surgical straight, Atom, and laparoscopic) were utilized depending on location and size. Nine patients underwent additional procedures including partial hepatectomies, colectomy, and gastrectomy. Total median ablation time was 10 minutes (range 5 to 22.5). There were no perioperative mortalities, with perioperative morbidity occurring in 5 patients, none of them related to hepatic ablation. After a median follow-up of 6 months there have been no ablation recurrences. Microwave ablation represents a faster and safer way to perform hepatic ablations in patients. The ability to perform bracketed ablations in tumors that are not perfectly spherical