Background Combination therapy using hepatic resection (HR) and intra-operative thermal ablation is a treatment approach for patients with technically unresectable liver malignancies. The aim of this study was to investigate safety, survival and local recurrence rates for patients with technically unresectable liver tumors undergoing HR and separate percutaneous MR-guided thermoablation procedure as an alternative approach. Methods Data from all patients with primary or secondary hepatic malignancies treated at a single institution between 2004 and 2018 with combined HR and MR-guided percutaneous thermoablation was collected and retrospectively analyzed. Complications, procedure related information and patient characteristics were collected from institutional records. Overall survival and disease-free survival were estimated using the Kaplan-Meier method. Results A total of 31 patients (age: 62.8 ± 9.1 years; 10 female) with hepatocellular carcinoma (HCC; n = 7) or hepatic metastases ( n = 24) were treated for 98 hepatic tumors. Fifty-six tumors (mean diameter 28.7 ± 23.0 mm) were resected. Forty-two tumors (15.1 ± 7.6 mm) were treated with MR-guided percutaneous ablation with a technical success rate of 100%. Local recurrence at the ablation site occurred in 7 cases (22.6%); none of these was an isolated local recurrence. Six of 17 patients (35.3%) treated for colorectal liver metastases developed local recurrence. Five patients developed recurrence at the resection site (16.1%). Non-local hepatic recurrence was observed in 18 cases (58.1%) and extrahepatic recurrence in 11 cases (35.5%) during follow-up (43.1 ± 26.4 months). Ten patients (32.3%) developed complications after HR requiring pharmacological or interventional treatment. No complication requiring therapy was observed after ablation. Median survival time was 44.0 ± 7.5 months with 1-,3-, 5-year overall survival rates of 93.5, 68.7 and 31.9%, respectively. The 1-, 3- and 5-year disease-free survival rates were 38.7, 19.4 and 9.7%, respectively. Conclusion The combination of HR and MR-guided thermoablation is a safe and effective approach in the treatment of technically unresectable hepatic tumors and can achieve long-term survival.

中文翻译：

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MRI 引导下经皮热消融联合肝切除术作为原发性和继发性肝脏恶性肿瘤患者的实质保留方法：单中心长期经验

背景 使用肝切除术 (HR) 和术中热消融的联合治疗是治疗技术上无法切除的肝脏恶性肿瘤患者的一种治疗方法。本研究的目的是调查接受 HR 和单独经皮 MR 引导热消融手术作为替代方法的技术上不可切除的肝脏肿瘤患者的安全性、存活率和局部复发率。方法 收集 2004 年至 2018 年在同一机构接受联合 HR 和 MR 引导的经皮热消融术治疗的所有原发性或继发性肝脏恶性肿瘤患者的数据并进行回顾性分析。从机构记录中收集并发症、手术相关信息和患者特征。使用 Kaplan-Meier 方法估计总生存期和无病生存期。结果 共有 31 名肝细胞癌（HCC；n = 7）或肝转移（n = 24）患者（年龄：62.8 ± 9.1 岁；10 名女性）接受了 98 例肝脏肿瘤的治疗。切除了 56 个肿瘤（平均直径 28.7 ± 23.0 毫米）。42 个肿瘤 (15.1 ± 7.6 mm) 用 MR 引导的经皮消融治疗，技术成功率为 100%。消融部位局部复发7例（22.6%）；这些都不是孤立的局部复发。接受结直肠肝转移治疗的 17 名患者中有 6 名 (35.3%) 出现局部复发。5 名患者在切除部位出现复发（16.1%）。随访期间观察到肝非局部复发 18 例（58.1%）和肝外复发 11 例（35.5%）（43. 1 ± 26.4 个月）。10 名患者 (32.3%) 在 HR 后出现并发症，需要药物或介入治疗。消融后没有观察到需要治疗的并发症。中位生存时间为 44.0 ± 7.5 个月，1、3、5 年总生存率分别为 93.5%、68.7% 和 31.9%。1 年、3 年和 5 年无病生存率分别为 38.7%、19.4% 和 9.7%。结论 HR联合MR引导下热消融治疗技术上不可切除的肝脏肿瘤是一种安全有效的方法，可以实现长期生存。5 年总生存率分别为 93.5、68.7 和 31.9%。1 年、3 年和 5 年无病生存率分别为 38.7%、19.4% 和 9.7%。结论 HR联合MR引导下热消融治疗技术上不可切除的肝脏肿瘤是一种安全有效的方法，可以实现长期生存。5 年总生存率分别为 93.5、68.7 和 31.9%。1 年、3 年和 5 年无病生存率分别为 38.7%、19.4% 和 9.7%。结论 HR联合MR引导下热消融治疗技术上不可切除的肝脏肿瘤是一种安全有效的方法，可以实现长期生存。