Ryan C Pickens, MD1, Jesse K Sulzer, MD, PhD1, Allyson R Cochran, MSPH2, Lee Ocuin, MD1, Erin Baker1, John B Martinie, MD, FACS1, David A Iannitti, MD, FACS1, Dionisios Vrochides, MD, PhD, FACS, FRCSC1. 1Department of Surgery, Atrium Health, 2Carolinas Center for Surgical Outcomes Science, Atrium Health
Introduction: The objective of this study is to show that a minimally-invasive approach for microwave ablation (MWA) can effectively treat neuroendocrine liver metastases (NLM). Surgical MWA has emerged as a safe treatment for liver metastases and is ideally performed through a minimally-invasive approach. Existing data for MWA of NLM is limited. In this study we present our 10-year single-center experience of minimally-invasive MWA for neuendocrine liver metastases.
Methods and Procedures: A retrospective review of all patients undergoing surgical MWA from 2008 to 2018 at our tertiary institution was performed. All patients who underwent laparoscopic MWA for NLM were included. Outcomes included treatment modality, tumor characteristics, presence of symptoms and symptom improvement, regional and metastatic recurrence. Patients were divided into two groups based on whether MWA was performed for curative intent (no evidence of disease after ablation of all detectable liver tumors and no extrahepatic disease at the conclusion of the planned procedures) or cytoreduction (intentionally untreated intrahepatic or known extrahepatic disease). Success for curative intent was defined as no evidence disease on first post-ablation imaging from incomplete ablations or residual disease.
Results: Thirty-nine patients underwent surgical MWA for NLM during the study period. Sixty-nine percent (27/39) underwent ablation for curative intent, with 25.9% of those undergoing a concurrent hepatectomy (7/27). Patients with greater than 4 lesions or involvement of more than 3 hepatic segments were more likely to undergo a concurrent minimally-invasive hepatectomy. Thirty percent of patients treated with curative intent (8/27) were experiencing carcinoid symptoms refractory to medical therapy preoperatively. Treatment achieved a reduction in symptoms for 87.5% (7/8) through MWA alone (5/6) or MWA with hepatectomy (2/2). Follow-up imaging showed that 81.5% (22/27) of patients treated with curative intent were successfully achieved no evidence of disease. Median follow-up for patients treated with curative intent was 24.8 months (8.2-37.3 IQR) with regional recurrence in 40.7% (11/27) at a median time of 14.5 months (6.1-22.4 IQR). Patients who achieved successful cure had a median follow up of 25.4 months (7.7-39.1 IQR) with regional recurrence in 36% (8/22) at a median time of 18.4 months (12.8-23.7 IQR).
Conclusions: This 10-year single-center experience demonstrates that minimally-invasive microwave ablation for neuroendocrine liver metastases is an effective alternative for select patients. Patients with treated with curative intent (69%) with and without laparoscopic liver resection achieved successful cure from disease in 81.5% of cases and 87.5% experienced significant symptom improvement.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95321
Program Number: S016
Presentation Session: HPB
Presentation Type: Podium