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Keywords:
Abdomen, Liver, Ultrasound, Intraoperative, Metastases
Authors:
M. J. van Amerongen1, J. J. Futterer1, S. F. M. Jenniskens1, H. de Wilt1, E. van der Stok2, D. J. Grünhagen2, C. Verhoef2, A. Moelker2; 1Nijmegen/NL, 2Rotterdam/NL
DOI:
10.1594/ecr2015/C-1318
Methods and materials
For the treatment of CRLM,
1007 patients were prospectively included in a multicenter database of two university hospitals in the Netherlands between January 2000 and May 2013.
Of this database,
632 patients were included after exclusion of patients with extrahepatic disease,
two-staged operation of their disease,
synchronous surgery of both primary tumor and liver metastasis or loss of follow-up.
Both patients who received only surgery and the intraoperative combination with RFA,
received an open approach operation.
After mobilization,
the liver was inspected using palpation and intraoperative ultrasound to locate the metastases.
For surgical resection,
the Cavitron Ultrasonic Surgical Aspirator (CUSA) was used.
R1 resections were pathologically defined by the presence of microscopic tumor invasion of the resection margin and R0 was defined by the absence thereof(4).
In the same session,
the patients of the combination group received RFA of the remaining lesions.
A Cool-TipTM (Covidien,
Boulder,
CO,
USA) RFA needle was placed at an optimal location as to achieve a 1 cm margin around the tumor.
A single needle was used for lesions of less than 2 cm,
whereas a needle cluster was used for larger lesions.
The Clavien-Dindo et al.
classification was used for the assessment of postoperative complications(5).
In specific,
the intra-abdominal abscess and other infections were registered.
Death within 90 days after the intervention was defined as postoperative mortality.
Further follow-up included CEA measurements and clinical evaluation of the patients.
In Erasmus MC Cancer Institute radiological imaging (liver ultrasound and/or CT chest/abdomen) was performed in the first year at every 4 months,
in the second year every 6 months and after this once a year.
In Radboud University Medical Center Nijmegen evaluation was performed every 3 months in the first 3 years and in the fourth and fifth year,
every 6 months.
The time period between the first recurrence and hepatic intervention was defined as Disease-Free Survival (DFS).
The interval between intervention and death of the patient was considered the Overall Survival (OS).