Thoracoscopic Ablation of Critically Located Liver Tumors: A Safety and Efficacy Cohort Study
Background: Liver resection represents the first curative treatment to treat primary and secondary hepatic tumors. Thoracoscopic liver ablation is a viable and minimally invasive alternative treatment, especially for patients with previous multiple abdominal surgeries. The aim of the study was to ev...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2021-03-01
|
| Series: | Frontiers in Surgery |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fsurg.2021.626297/full |
| _version_ | 1811271100633448448 |
|---|---|
| author | Umberto Cillo Michele Finotti Chiara Di Renzo Alessandro Vitale Giacomo Zanus Enrico Gringeri Alessandra Bertacco Marina Polacco Francesco D'Amico Francesco D'Amico |
| author_facet | Umberto Cillo Michele Finotti Chiara Di Renzo Alessandro Vitale Giacomo Zanus Enrico Gringeri Alessandra Bertacco Marina Polacco Francesco D'Amico Francesco D'Amico |
| author_sort | Umberto Cillo |
| collection | DOAJ |
| description | Background: Liver resection represents the first curative treatment to treat primary and secondary hepatic tumors. Thoracoscopic liver ablation is a viable and minimally invasive alternative treatment, especially for patients with previous multiple abdominal surgeries. The aim of the study was to evaluate the safety and efficacy of thoracoscopic ablation for liver tumors.Methods: Retrospective analysis of a prospective database of patients with liver tumors, treated with thoracoscopic trans-diagrammatic ablation (MWA or RFA) at our institution from 2012 to 2018. The primary endpoint was post-operative mortality at 30 days, while secondary endpoints were morbidity and efficacy of ablation (i.e., response rate evaluated according to mRECIST criteria, and overall patient survival). Patient demographics, operational characteristics, and complications were recorded.Results: A total of 13 nodules were treated in 10 patients with a median age of 65.5 years. Post-operative mortality was 0%, and overall morbidity was 40% (Clavien-Dindo I complications 30%, II 0%, III 10%, IV 0%). Complete radiological response was obtained in 83.3% of nodules at 3 months. After a median follow-up of 20.95 months, the local tumor progression rate was 30%, with an intra-segmental-recurrence of 30%, and an intra-hepatic-recurrence of 30%. The overall 1-, 2-, and 3-years survival rates were 80%, 58%, and 58%.Conclusion: Thoracoscopic trans-diaphragmatic ablation proved to be a safe and effective way to treat liver tumors when abdominal approach is not feasible. Considering the low morbidity, it is a viable option to treat patients with recurrent disease and/or previous multiple abdominal surgeries. |
| first_indexed | 2024-04-12T22:14:08Z |
| format | Article |
| id | doaj.art-66936e5d5b004f95a1ec9c0beecddfcc |
| institution | Directory Open Access Journal |
| issn | 2296-875X |
| language | English |
| last_indexed | 2024-04-12T22:14:08Z |
| publishDate | 2021-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Surgery |
| spelling | doaj.art-66936e5d5b004f95a1ec9c0beecddfcc2022-12-22T03:14:37ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2021-03-01810.3389/fsurg.2021.626297626297Thoracoscopic Ablation of Critically Located Liver Tumors: A Safety and Efficacy Cohort StudyUmberto Cillo0Michele Finotti1Chiara Di Renzo2Alessandro Vitale3Giacomo Zanus4Enrico Gringeri5Alessandra Bertacco6Marina Polacco7Francesco D'Amico8Francesco D'Amico9Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation, Padova University, Padova, ItalyDepartment of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation, Padova University, Padova, ItalyDepartment of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation, Padova University, Padova, ItalyDepartment of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation, Padova University, Padova, ItalyDepartment of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation, Padova University, Padova, ItalyDepartment of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation, Padova University, Padova, ItalyDepartment of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation, Padova University, Padova, ItalyDepartment of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation, Padova University, Padova, ItalyDepartment of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation, Padova University, Padova, ItalyDepartment of Surgery, Immunology and Transplantation Unit, Yale University, New Haven, CT, United StatesBackground: Liver resection represents the first curative treatment to treat primary and secondary hepatic tumors. Thoracoscopic liver ablation is a viable and minimally invasive alternative treatment, especially for patients with previous multiple abdominal surgeries. The aim of the study was to evaluate the safety and efficacy of thoracoscopic ablation for liver tumors.Methods: Retrospective analysis of a prospective database of patients with liver tumors, treated with thoracoscopic trans-diagrammatic ablation (MWA or RFA) at our institution from 2012 to 2018. The primary endpoint was post-operative mortality at 30 days, while secondary endpoints were morbidity and efficacy of ablation (i.e., response rate evaluated according to mRECIST criteria, and overall patient survival). Patient demographics, operational characteristics, and complications were recorded.Results: A total of 13 nodules were treated in 10 patients with a median age of 65.5 years. Post-operative mortality was 0%, and overall morbidity was 40% (Clavien-Dindo I complications 30%, II 0%, III 10%, IV 0%). Complete radiological response was obtained in 83.3% of nodules at 3 months. After a median follow-up of 20.95 months, the local tumor progression rate was 30%, with an intra-segmental-recurrence of 30%, and an intra-hepatic-recurrence of 30%. The overall 1-, 2-, and 3-years survival rates were 80%, 58%, and 58%.Conclusion: Thoracoscopic trans-diaphragmatic ablation proved to be a safe and effective way to treat liver tumors when abdominal approach is not feasible. Considering the low morbidity, it is a viable option to treat patients with recurrent disease and/or previous multiple abdominal surgeries.https://www.frontiersin.org/articles/10.3389/fsurg.2021.626297/fullhepatocellular carcinomacolon rectal liver metastasesmicrowave ablationminimal invasive treatmentsthoracoscopic liver ablationtrans-diaphragmatic approach |
| spellingShingle | Umberto Cillo Michele Finotti Chiara Di Renzo Alessandro Vitale Giacomo Zanus Enrico Gringeri Alessandra Bertacco Marina Polacco Francesco D'Amico Francesco D'Amico Thoracoscopic Ablation of Critically Located Liver Tumors: A Safety and Efficacy Cohort Study Frontiers in Surgery hepatocellular carcinoma colon rectal liver metastases microwave ablation minimal invasive treatments thoracoscopic liver ablation trans-diaphragmatic approach |
| title | Thoracoscopic Ablation of Critically Located Liver Tumors: A Safety and Efficacy Cohort Study |
| title_full | Thoracoscopic Ablation of Critically Located Liver Tumors: A Safety and Efficacy Cohort Study |
| title_fullStr | Thoracoscopic Ablation of Critically Located Liver Tumors: A Safety and Efficacy Cohort Study |
| title_full_unstemmed | Thoracoscopic Ablation of Critically Located Liver Tumors: A Safety and Efficacy Cohort Study |
| title_short | Thoracoscopic Ablation of Critically Located Liver Tumors: A Safety and Efficacy Cohort Study |
| title_sort | thoracoscopic ablation of critically located liver tumors a safety and efficacy cohort study |
| topic | hepatocellular carcinoma colon rectal liver metastases microwave ablation minimal invasive treatments thoracoscopic liver ablation trans-diaphragmatic approach |
| url | https://www.frontiersin.org/articles/10.3389/fsurg.2021.626297/full |
| work_keys_str_mv | AT umbertocillo thoracoscopicablationofcriticallylocatedlivertumorsasafetyandefficacycohortstudy AT michelefinotti thoracoscopicablationofcriticallylocatedlivertumorsasafetyandefficacycohortstudy AT chiaradirenzo thoracoscopicablationofcriticallylocatedlivertumorsasafetyandefficacycohortstudy AT alessandrovitale thoracoscopicablationofcriticallylocatedlivertumorsasafetyandefficacycohortstudy AT giacomozanus thoracoscopicablationofcriticallylocatedlivertumorsasafetyandefficacycohortstudy AT enricogringeri thoracoscopicablationofcriticallylocatedlivertumorsasafetyandefficacycohortstudy AT alessandrabertacco thoracoscopicablationofcriticallylocatedlivertumorsasafetyandefficacycohortstudy AT marinapolacco thoracoscopicablationofcriticallylocatedlivertumorsasafetyandefficacycohortstudy AT francescodamico thoracoscopicablationofcriticallylocatedlivertumorsasafetyandefficacycohortstudy AT francescodamico thoracoscopicablationofcriticallylocatedlivertumorsasafetyandefficacycohortstudy |