Liver resection and ablation for squamous cell carcinoma liver metastases.

BACKGROUND: Limited evidence exists to guide the management of patients with liver metastases from squamous cell carcinoma (SCC). The aim of this retrospective multicentre cohort study was to describe patterns of disease recurrence after liver resection/ablation for SCC liver metastases and factors associated with recurrence-free survival (RFS) and overall survival (OS). METHOD: Members of the European-African Hepato-Pancreato-Biliary Association were invited to include all consecutive patients undergoing liver resection/ablation for SCC liver metastases between 2002 and 2019. Patient, tumour and perioperative characteristics were analysed with regard to RFS and OS. RESULTS: Among the 102 patients included from 24 European centres, 56 patients had anal cancer, and 46 patients had SCC from other origin. RFS in patients with anal cancer and non-anal cancer was 16 and 9 months, respectively (P = 0.134). A positive resection margin significantly influenced RFS for both anal cancer and non-anal cancer liver metastases (hazard ratio 6.82, 95 per cent c.i. 2.40 to 19.35, for the entire cohort). Median survival duration and 5-year OS rate among patients with anal cancer and non-anal cancer were 50 months and 45 per cent and 21 months and 25 per cent, respectively. For the entire cohort, only non-radical resection was associated with worse overall survival (hazard ratio 3.21, 95 per cent c.i. 1.24 to 8.30). CONCLUSION: Liver resection/ablation of liver metastases from SCC can result in long-term survival. Survival was superior in treated patients with liver metastases from anal versus non-anal cancer. A negative resection margin is paramount for acceptable outcome.

Fate of necrotic volume after microwave ablation of multiple liver metastases.

BACKGROUND/AIMS: The aim of this study was to find the rate of shrinkage of necrosis and time of peak ablation volume after multiple microwave ablations in the treatment of multiple liver metastases of colorectal cancer. These factors are not known and are important in evaluation of treatment and identification of local recurrence, as microwave treatment is becoming more used thanks to improved technology in diagnostics and interventional therapy. METHODOLOGY: A retrospective analysis of non-cirrhotic patients with multiple liver only metastases of colorectal cancer, not suited for resection for this reason. Patients were selected for palliative microwave treatment at a liver multidisciplinary team conference. 68 ablations were made in six patients. Ablation volume was analysed with repeated imaging and computer analyses. RESULTS: The ablation volume peeks after 5-7 days where after reduction of the necrosis in the liver occurs logarithmically with a 60% reduction of ablation volume after 100 days and 80% after a year. DISCUSSION: Liver regeneration after microwave ablations occurs at a constant logarithmic rate after an initial expansion of the ablation volume during the first five days. Evaluation of ablation volume in comparison to tumour volume must take this into account so that follow-up imaging is properly timed.

A multiple microwave ablation strategy in patients with initially unresectable colorectal cancer liver metastases - A safety and feasibility study of a new concept.

AIMS: Resection for colorectal cancer liver metastases is indicated when an R0 resection with preservation of a sufficient future liver remnant (FLR) is achievable. Multimodality conversion of initially unresectable patients to resectable is possible in some patients. We present results of a downstaging strategy using microwave ablation (MWA). PATIENTS AND METHODS: In patients where resection was precluded by absence of a tumour-free FLR due to the extent of segmental tumour engagement, but with the potential to clear the whole liver with multiple local ablations, MWA was performed at laparotomy using ultrasound guidance or computer-assisted navigation. Mortality and morbidity was recorded and the overall and disease-free survival of the ablated patients was compared to data of two historic cohorts. RESULTS: Ten of twenty treated patients were alive at median follow-up 25 months. There was no perioperative mortality, with MWA-associated complications being mild to moderate. The MWA group showed a 4-year overall survival of 41%, compared to 70% for a historic cohort of primarily resected patients and 4% for patients with palliative treatment. CONCLUSION: Results of the multiple ablation strategy in the defined population suggest a survival benefit, compared to palliative chemotherapy alone with acceptable associated morbidity and no perioperative mortality.

Rehabilitation of the patient with a lower extremity amputation.

Preservation of life is an incomplete and inadequate objective for the lower extremity amputee. A comprehensive rehabilitation program must be designed to meet his individual needs. This is the responsibility of the professional community that purports to treat disease and maintain the health of the population. The multidisciplinary team functions in a coordinated effort to identify and resolve the amputee's problems, and to establish realistic goals during each phase of his rehabilitation program. The rehabilitation process begins when the prospective LE amputee is identified and continues until he has achieved optimal independence; that is, he has learned to cope with his disability within the boundaries of his normal environment.