Application of Laparoscopic Hepatectomy Combined with Intraoperative Microwave Ablation in Colorectal Cancer Liver Metastasis

Summary

This protocol describes the laparoscopic resection of colorectal cancer liver metastases combined with ultrasound-guided microwave ablation. This technique can safely, effectively, and accurately treat refractory liver metastases <3 cm, reduce postoperative complications, and accelerate the postoperative rehabilitation of patients.

Abstract

Laparoscopic hepatectomy is a common treatment for colorectal cancer liver metastasis. Previously, a sufficient number of functional liver masses had to be maintained during laparoscopic hepatectomy, with a residual liver volume of >40% in cirrhotic patients and >30% in non-cirrhotic patients. The high incidence of complications such as bleeding, bile leakage, or liver failure due to the exposure and difficulty of the resection of specific liver segments such as S2 and S7 reduces the success rate of liver resection. At present, microwave ablation is mainly applied in the treatment of liver metastasis using a percutaneous approach, which makes it difficult to identify hidden parts or small lesions. For some liver segments, the percutaneous puncture of liver segment 7 (S7) is likely to pass through the thoracic cavity, and the percutaneous puncture of liver segment 2 (S2) adjacent to the diaphragm is likely to injure the diaphragm and heart; these issues restrict the application of percutaneous ablation in colorectal cancer liver metastasis. Considering multiple lesions, laparoscopic microwave ablation combined with hepatectomy was performed in this study. The location of the lesions was determined by contrast-enhanced ultrasound under laparoscopy, and small lesions that were difficult to detect before the operation were identified. For the scattered lesions, which had diameters less than 3 cm and were difficult to resect, ablation was adopted to substitute hepatectomy. This technique helped to more explicitly locate the tumors, simplified the operation procedures, reduced the risk of complications such as bleeding and bile leakage, shortened the operation time, accelerated the postoperative recovery, significantly improved the success rate of operation, and enhanced the clinical prognosis of colorectal cancer liver metastasis by surgical resection.

Introduction

Colorectal cancer is the third most common cause of cancer-related death worldwide¹, and the most common site of hematogenous metastases from colorectal cancer is the liver; this metastasis occurs in up to 50% of colorectal patients and is the leading cause of death in colorectal cancer patients². For colorectal cancer patients without liver metastases, survival can be prolonged by surgical resection and postoperative adjuvant chemotherapy, and interventional techniques. In the case of resectable liver metastases, those with a diameter of less than 3 cm can be treated by surgical local excision, radiological interve....

Protocol

This study was approved by the Ethics Committee of the Sixth Affiliated Hospital, Sun Yat-sen University. The diagnostic criteria and treatment strategies refer to Chinese guidelines for the diagnosis and comprehensive treatment of colorectal liver metastases (version 2018) and the Shanghai International Consensus on Diagnosis and Comprehensive Treatment of Colorectal Liver Metastases (Version 2019). The patient had clinical symptoms such as hematochezia, intestinal obstruction, liver pain, and weight loss. Patients with.......

Discussion

The main metastatic site of colorectal cancer metastasis is the liver. Liver resection is the treatment for colorectal cancer liver metastases, and liver resection can improve the survival rate of patients¹¹. As colorectal cancer metastasizes to the liver through the blood, resulting in multiple liver metastases in both lobes, and the remaining liver volume is small, about 75% of liver metastases in colorectal cancer patients cannot be surgically removed¹². Systemic chemoth.......

Materials

Name	Company	Catalog Number	Comments
0.9% sodium chloride solution	Foshan Shuanghe Commercial Co., Ltd	H20013095	Dilute antibiotics, irrigate.
2-0 polyglactin 910 sutures	Johnson & Johnson Medical Devices	W8400	Close the Trocar hole.
3 D laparoscopic	STORZ	26605BA	Surgical treatment under direct vision, minimally invasive
Absorbable Hemostat	ETHICON	1962	wound hemostasis
BiClamp E Lap	ERBE Elektromedizin GmbH	20195-136	Intraoperative wound hemostasis
Cefoperazone Sulbactam Sodium	Pfizer Pharmaceuticals Ltd	H20020597	infection prevention
Laparoscopic ultrasound probe	HITACHI	ALOKA-UST5418	Intraoperative localization of liver metastases
LIGACLIP Multiple Clip Applier and Ligating Clips	Ethicon Endo - Surgery, LLC	ER320	Clamp tiny blood vessels and bile ducts
Microwave ablation System	Nanjing Yigao Microwave System Engineering Co., Ltd, China	ECO-100A110	Microwave ablation of liver metastases
Polymer ligation clips	Teleflex Medical, USA	Hem-lock544233	Clipping of broken ends of blood vessels and bile ducts
Silica gel drainage tube	BAINUS MEDICAL	YY-Fr16	Drainage of peritoneal fluid
Ultrasonic knife	Johnson & Johnson Medical Devices	HAR36	Tissue cutting, microvascular hemostasis