Case Report
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World J Gastroenterol. Oct 28, 2014; 20(40): 14992-14996
Published online Oct 28, 2014. doi: 10.3748/wjg.v20.i40.14992
Computer planned, image-guided combined resection and ablation for bilobar colorectal liver metastases
Vanessa M Banz, Matthias Baechtold, Stefan Weber, Matthias Peterhans, Daniel Inderbitzin, Daniel Candinas
Vanessa M Banz, Matthias Baechtold, Daniel Inderbitzin, Daniel Candinas, Department of Visceral Surgery and Medicine, Inselspital, Berne University Hospital and University of Berne, CH-3010 Berne, Switzerland
Stefan Weber, Matthias Peterhans, ARTORG Center for Computer-Aided Surgery, University of Berne, CH-3010 Berne, Switzerland
Author contributions: Weber S, Inderbitzin D and Candinas D designed the research; Banz VM, Inderbitzin D and Candinas D performed the research; Weber S and Peterhans M contributed new reagents or analytic tools; Banz VM, Baechtold M and Peterhans M analyzed the data; Banz VM, Weber S and Baechtold M wrote the paper.
Correspondence to: Daniel Candinas, MD, FRCS, Professor, Department of Visceral Surgery and Medicine, Inselspital, Berne University Hospital and University of Berne, CH-3010 Berne, Switzerland. daniel.candinas@insel.ch
Telephone: +41-31-6322404 Fax: +41-31-3824772
Received: January 7, 2014
Revised: May 19, 2014
Accepted: July 16, 2014
Published online: October 28, 2014
Abstract

For patients with extensive bilobar colorectal liver metastases (CRLM), initial surgery may not be feasible and a multimodal approach including microwave ablation (MWA) provides the only chance for prolonged survival. Intraoperative navigation systems may improve the accuracy of ablation and surgical resection of so-called “vanishing lesions”, ultimately improving patient outcome. Clinical application of intraoperative navigated liver surgery is illustrated in a patient undergoing combined resection/MWA for multiple, synchronous, bilobar CRLM. Regular follow-up with computed tomography (CT) allowed for temporal development of the ablation zones. Of the ten lesions detected in a preoperative CT scan, the largest lesion was resected and the others were ablated using an intraoperative navigation system. Twelve months post-surgery a new lesion (Seg IVa) was detected and treated by trans-arterial embolization. Nineteen months post-surgery new liver and lung metastases were detected and a palliative chemotherapy started. The patient passed away four years after initial diagnosis. For patients with extensive CRLM not treatable by standard surgery, navigated MWA/resection may provide excellent tumor control, improving longer-term survival. Intraoperative navigation systems provide precise, real-time information to the surgeon, aiding the decision-making process and substantially improving the accuracy of both ablation and resection. Regular follow-ups including 3D modeling allow for early discrimination between ablation zones and recurrent tumor lesions.

Keywords: Computer navigation, Colorectal liver metastases, Image-guidance, Microwave ablation, Tumor

Core tip: For patients with extensive bilobar colorectal liver metastases (CRLM), surgery may not be an option and a multimodal approach including computer navigated intervention may be the only chance for prolonged survival. Here we report on a 59-year-old patient undergoing combined resection/microwave ablation for multiple, synchronous bilobar CRLM using an intraoperative navigation system. Of the ten lesions detected in a preoperative computed tomography scan, the largest was resected and the remaining nine ablated. Navigated interventions may provide excellent tumor control, possibly improve longer-term survival, provide real-time information to the surgeon, thus aiding the decision-making process and substantially improving ablation and resection accuracy.