Preliminary coagulation of a vein adjacent to colorectal cancer metastases in the liver as a way to increase the effectiveness of radiofrequency ablation

Abstract

Aim: to evaluate the efficacy and safety of prior coagulation of the vein adjacent to the tumor node within ultrasound-directed percutaneous radiofrequency thermal ablation (RFTA) of perivascular liver metastases of colorectal cancer (CRC). Patients and Methods: in this open-label single-site retrospective study a medical health record analysis was performed to include CRC patients with perivascular liver metastasis who received ultrasound-directed RFTA within 2014–2020 timeframe. Total study population included 51 patients. Patients were stratified in two arms by the type of surgical intervention they have received: experimental arm — 23 (45%) subjects (mean age 62.0 years) who underwent RFTA with prior adjacent vein coagulation, and control arm — 28 (55%) subjects (mean age 60.5 years) who underwent RFTA with no prior vein coagulation. Study groups were similar by the main parameters. Results: as it was shown by the computed tomography scan the incidence of residual tumor after RFTA was remarkably low in experimental arm versus control (17,4% vs. 21,4%). Relapse free survival (RFS) rate in 6 and 12 months follow up period was also higher in the experimental group versus control: RFSmo. — 65,2% vs. 56,5% (p=0,03), RFSmo. — 56,5% vs. 39,3% (p=0,04) in experimental and control groups respectively. Periprocedural complications rate was similar in both arms. Conclusion: prior coagulation of the vein adjacent to the tumor node within ultrasound-directed RFTA of perivascular CRC liver metastases can reduce the heat removal effect in the RFTA area and, thereby, increase the ablation treatment outcomes without any additional significant changes in healthy hepatic tissue. As a result, we can see an improvement in the short– and long–term treatment outcomes: a decrease of residual tumor incidence i.e. improve radicality of tumor destruction within the area of RFTA, and PFS improvement through 6 and 12 months follow up period. KEYWORDS: radiofrequency thermal ablation, liver metastases, coagulation, local thermal exposure, ultrasound diagnostics, computed tomography. FOR CITATION: Murashko K.L., Yurkovskiy A.M., Sorokin V.G. et al. Preliminary coagulation of a vein adjacent to colorectal cancer metastases in the liver as a way to increase the effectiveness of radiofrequency ablation. Russian Medical Inquiry. 2022;6(6):314–318 (in Russ.). DOI: 10.32364/2587-6821-2022-6-6-314-318.