Assistant Professor of Surgery, Surgery Section, Rocky Mountain Regional Veterans Affairs Medical Center and the University of Colorado, Aurora, CO.
Ann Surg. 2019 Oct;270(4):675-680. doi: 10.1097/SLA.0000000000003474.
To determine the impact of radiofrequency (RF) and microwave (MW) energy compared to direct cautery on metatstatic colon cancer growth.
Hepatic ablation with MW and RF energy creates a temperature gradient around a target site with temperatures known to create tissue injury and cell death. In contrast, direct heat application (cautery) vaporizes tissue with a higher site temperature but reduced heat gradient on surrounding tissue. We hypothesize that different energy devices create variable zones of sublethal injury that may promote tumor recurrence. To test this hypothesis we applied MW, RF, and cautery to normal murine liver with a concomitant metastatic colon cancer challenge.
C57/Bl6 mice received hepatic thermal injury with MW, RF, or cautery to create a superficial 3-mm lesion immediately after intrasplenic injection of 50K MC38 colon cancer cells. Thermal imaging recorded tissue temperature during ablation and for 10 seconds after energy cessation. Hepatic tumor location and volume was determined at day 7.
Cautery demonstrated the highest maximum tissue temperatures (129°C) with more rapid return to baseline compared to MW or RF energy. All mice had metastasis at the ablation site. Mean tumor volume was significantly greater in the MW (95.3 mm; P = 0.007) and RF (55.7 mm; P = 0.015) than cautery (7.13 mm). There was no difference in volume between MW and RF energy (P = 0.2).
Hepatic thermal ablation promotes colon cancer metastasis at the injury site. MV and RF energy result in greater metastatic volume than cautery. These data suggest that the method of energy delivery promotes local metastasis.
比较射频(RF)和微波(MW)能量与直接烧灼对转移性结肠癌生长的影响。
MW 和 RF 能量的肝消融在靶部位周围产生温度梯度,已知该温度梯度会造成组织损伤和细胞死亡。相比之下,直接热应用(烧灼)会使组织蒸发,靶部位温度较高,但周围组织的热梯度降低。我们假设不同的能量装置会产生不同的亚致死损伤区,从而可能促进肿瘤复发。为了验证这一假设,我们在伴有转移性结肠癌细胞挑战的情况下,将 MW、RF 和烧灼应用于正常的鼠肝。
C57/Bl6 小鼠在脾内注射 50K MC38 结肠癌细胞后,立即接受 MW、RF 或烧灼治疗,在肝内造成 3mm 深的浅层损伤。热成像记录消融过程中的组织温度以及能量停止后 10 秒的温度。在第 7 天确定肝肿瘤的位置和体积。
烧灼产生的最高组织温度(129°C)最高,与 MW 或 RF 能量相比,其温度迅速恢复到基线。所有小鼠的消融部位均有转移。MW(95.3mm;P = 0.007)和 RF(55.7mm;P = 0.015)的肿瘤体积明显大于烧灼(7.13mm)。MW 和 RF 之间的体积无差异(P = 0.2)。
肝热消融会促进损伤部位的结肠癌转移。MW 和 RF 能量导致的转移性肿瘤体积大于烧灼。这些数据表明,能量传递方式促进了局部转移。