Colorectal liver metastases: making the unresectable resectable using irreversible electroporation for microscopic positive margins – a case report

BMC Cancer

Singh Gagandeep²  Yuman Fong²  Jonathan Kessler¹  Shaila J Merchant²  Bryan Goldner²  Hans F Schoellhammer² 

[1]Division of Interventional Radiology, Department of Radiology, City of Hope Comprehensive Cancer Center, 1500 E. Duarte Road, Duarte 91010, CA, USA

[2]Division of Surgical Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center, 1500 E. Duarte Road, Duarte 91010, CA, USA

关键词: Metastasectomy;    Liver resection;    CRLM;    IRE;    Margin ablation;    Colorectal liver metastases;    Irreversible electroporation;   

Others  :  1171671
DOI  :  10.1186/s12885-015-1279-9

 received in 2014-10-23, accepted in 2015-03-26,  发布年份 2015

【 摘 要 】

Background

Irreversible electroporation (IRE) is a non-thermal injury tissue ablation technique that uses electrical pulses to cause cell death. IRE damages the endothelial cells of blood vessels; however these cells re-grow, and thus IRE does not result in permanent damage to blood vessels. We report the novel use of IRE for ablation of microscopically positive margins after resection of colorectal liver metastases (CRLM) impinging on hepatic veins.

Case presentation

A 68-year-old female was found to have colon cancer and synchronous bilateral unresectable liver metastases. Chemotherapy with FOLFOX and cetuximab was initiated, with subsequent conversion to resectability of the CRLM. The patient underwent colectomy followed by right liver posterior sectionectomy with wedge resection of segment 5. Resection of tumor impinging on the left and middle hepatic veins would have required left hepatectomy, with insufficient remnant liver volume. The CRLM were meticulously dissected off the hepatic veins leaving a microscopically positive margin, and IRE was then used for margin ablation, leaving intact hepatic veins and venous blood flow. The patient is alive and without recurrent disease now 30 months after resection. Herein we review the IRE technology and its use in ablation of liver metastases.

Conclusions

Use of IRE margin ablation for microscopically-positive CRLM resection may lead to long-term patient survival; further prospective randomized trials are needed to confirm this finding.

【 授权许可】

   
2015 Schoellhammer et al.; licensee BioMed Central.

【 图 表 】

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