Abstract

Objectives

To compare the ablation margins and safety of microwave ablation (MWA) of perivascular versus non-perivascular liver metastases from colorectal cancer (CRC) and to determine the risk factors for local tumor progression (LTP) after perivascular MWA.

Methods

Between June 2017 and June 2019, 84 metastases were treated: 39 perivascular (<5 mm from a vessel >3 mm), and 46 non-perivascular. Perivascular metastases were treated with either conventional or optimized protocols (maximum power and/or several heating cycles after repositioning the needle regardless of the initial tumor dimensions). The mean diameter of metastases was 15.4 mm (SD: 7.56).

Results

Vascular proximity did not result in a significant difference in ablation margins. The technical success rate, primary efficacy, and secondary efficacy were 90%, 66%, and 83%, respectively. Perivascular location was not a risk factor for time to LTP (p = 0.49), RFS (p = 0.52), or OS (p = 0.54). LTP was statistically related to the presence of a colonic obstruction (p < 0.05), number of metastases at the time of diagnosis (p < 0.05), type of protocol (p < 0.05), ablation margins (p < 0.001) and LTP was proportional to the number of liver resections before MWA (p < 0.05). There was no LTP in tumors ablated with margins over 10 mm. Two grade 4 complications occurred.

Conclusion

MWA is an effective and safe treatment for perivascular liver metastases from CRC, provided that satisfactory margins are achieved. A maximalist attitude could be related to better local control.

中文翻译：

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结直肠癌血管周围肝转移的计算机断层扫描引导微波消融：消融区、可行性和安全性的研究

摘要

目标

比较结直肠癌 (CRC) 血管周围和非血管周围肝转移的微波消融 (MWA) 的消融边缘和安全性，并确定血管周围 MWA 后局部肿瘤进展 (LTP) 的危险因素。

方法

2017 年 6 月至 2019 年 6 月期间，共治疗了 84 处转移灶：39 处血管周围（距离血管 >3 mm 的 <5 mm）和 46 处非血管周围。血管周围转移瘤采用常规或优化方案（最大功率和/或重新定位针头后的几个加热周期，无论初始肿瘤尺寸如何）进行治疗。转移灶的平均直径为 15.4 毫米（标准差：7.56）。

结果

血管接近度不会导致消融边缘的显着差异。技术成功率、一级疗效和二级疗效分别为90%、66%和83%。血管周围位置不是 LTP ( p  = 0.49)、RFS ( p  = 0.52) 或 OS ( p  = 0.54)时间的危险因素。LTP 与结肠梗阻的存在 ( p  < 0.05)、诊断时的转移数量 ( p  < 0.05)、方案类型 ( p  < 0.05)、消融边缘 ( p  < 0.001) 和 LTP 具有统计学相关性与 MWA 前肝切除次数成正比 ( p < 0.05)。切缘超过 10 mm 的肿瘤消融没有 LTP。发生了两个 4 级并发症。

结论

MWA 是治疗 CRC 血管周围肝转移的有效且安全的方法，前提是切缘令人满意。极端主义的态度可能与更好的局部控制有关。