Department of Visceral Surgery and Medicine, Inselspital, University Hospital Bern, University of Bern, 3010, Bern, Switzerland.
ARTORG Center for Biomedical Engineering Research, University of Bern, 3010, Bern, Switzerland.
Surg Endosc. 2017 Oct;31(10):4315-4324. doi: 10.1007/s00464-017-5458-4. Epub 2017 Mar 24.
Stereotactic navigation technology has been proposed to augment accuracy in targeting intrahepatic lesions for local ablation therapy. This retrospective study evaluated accuracy, efficacy, and safety when using laparoscopic image-guided microwave ablation (LIMA) for malignant liver tumors.
All patients treated for malignant liver lesions using LIMA at two European centers between 2013 and 2015 were included for analysis. A landmark-based registration technique was applied for intraoperative tumor localization and positioning of ablation probes. Intraoperative efficiency of the procedure was measured as number of registration attempts and time needed to achieve sufficient registration accuracy. Technical accuracy was assessed as Fiducial Registration Error (FRE). Outcome at 90 days including mortality, postoperative morbidity, rates of incomplete ablations, and early intrahepatic recurrences were reported.
In 34 months, 54 interventions were performed comprising a total of 346 lesions (median lesions per patient 3 (1-25)). Eleven patients had concomitant laparoscopic resections of the liver or the colorectal primary tumor. Median time for registration was 4:38 min (0:26-19:34). Average FRE was 8.1 ± 2.8 mm. Follow-up at 90 days showed one death, 24% grade I/II, and 4% grade IIIa complications. Median length of hospital stay was 2 days (1-11). Early local recurrence was 9% per lesion and 32% per patient. Of these, 63% were successfully re-ablated within 6 months.
LIMA does not interfere with the intraoperative workflow and results in low complication and early local recurrence rates, even when simultaneously targeting multiple lesions. LIMA may represent a valid therapy option for patients with extensive hepatic disease within a multimodal treatment approach.
立体定向导航技术已被提出用于提高肝内病变局部消融治疗的靶向准确性。本回顾性研究评估了在欧洲两个中心使用腹腔镜图像引导微波消融（LIMA）治疗恶性肝肿瘤的准确性、疗效和安全性。
纳入 2013 年至 2015 年期间在两个欧洲中心使用 LIMA 治疗恶性肝病变的所有患者进行分析。应用基于标志的注册技术进行术中肿瘤定位和消融探针定位。术中程序效率以注册尝试次数和达到足够注册精度所需的时间来衡量。技术准确性评估为基准注册误差（FRE）。报告 90 天的结果，包括死亡率、术后发病率、不完全消融率和早期肝内复发率。
在 34 个月的时间里，共进行了 54 次干预，共治疗了 346 个病变（每个患者的中位数为 3 个（1-25））。11 例患者同时行腹腔镜肝切除术或结直肠原发病灶切除术。注册中位时间为 4:38 分钟（0:26-19:34）。平均 FRE 为 8.1±2.8mm。90 天随访显示，1 例死亡，24%为 I/II 级，4%为 IIIa 级并发症。中位住院时间为 2 天（1-11）。早期局部复发率为每个病变 9%，每个患者 32%。其中，63%的患者在 6 个月内成功再次消融。
LIMA 不会干扰术中工作流程，并且具有较低的并发症和早期局部复发率，即使同时靶向多个病变也是如此。LIMA 可能代表一种有效的治疗选择，适用于在多模式治疗方法中患有广泛肝疾病的患者。
