Cillo Umberto, Finotti Michele, Di Renzo Chiara, Vitale Alessandro, Zanus Giacomo, Gringeri Enrico, Bertacco Alessandra, Polacco Marina, D'Amico Francesco
Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation, Padova University, Padova, Italy.
Department of Surgery, Immunology and Transplantation Unit, Yale University, New Haven, CT, United States.
Front Surg. 2021 Mar 17;8:626297. doi: 10.3389/fsurg.2021.626297. eCollection 2021.
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. 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. 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%. 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.
肝切除术是治疗原发性和继发性肝肿瘤的首选根治性治疗方法。胸腔镜肝消融是一种可行的微创替代治疗方法，尤其适用于既往有多次腹部手术史的患者。本研究的目的是评估胸腔镜消融治疗肝肿瘤的安全性和有效性。对2012年至2018年在我院接受胸腔镜经膈肌消融（微波消融或射频消融）治疗的肝肿瘤患者的前瞻性数据库进行回顾性分析。主要终点是30天术后死亡率，次要终点是发病率和消融效果（即根据mRECIST标准评估的缓解率和患者总生存率）。记录患者的人口统计学资料、手术特征和并发症。10例患者共治疗13个结节，中位年龄65.5岁。术后死亡率为0%，总发病率为40%（Clavien-Dindo I级并发症30%，II级0%，III级10%，IV级0%）。3个月时83.3%的结节获得完全放射学缓解。中位随访20.95个月后，局部肿瘤进展率为30%，节段内复发率为30%，肝内复发率为30%。1年、2年和3年总生存率分别为80%、58%和58%。当腹部入路不可行时，胸腔镜经膈肌消融被证明是一种安全有效的肝肿瘤治疗方法。考虑到低发病率，对于复发性疾病和/或既往有多次腹部手术史的患者，这是一种可行的选择。
