This work does not have any funding sources.

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...

<ol>
	<li>Shi, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Long-term+results+of+percutaneous+microwave+ablation+for+colorectal+liver+metastases.">Long-term results of percutaneous microwave ablation for colorectal liver metastases.</a> HPB. 23 (1), 37-45 (2021).</li><li>Xu, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Chinese+guidelines+for+the+diagnosis+and+comprehensive+treatment+of+colorectal+liver+metastases+(version+2018).">Chinese guidelines for the diagnosis and comprehensive treatment of colorectal liver metastases (version 2018).</a> Journal of Cancer Research and Clinical Oncology. 145 (3), 725-736 (2019).</li><li>Schnitzbauer, A., Bechstein, W. O., Vogl, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=[Ablative+modalities+in+the+treatment+of+liver+metastases].">[Ablative modalities in the treatment of liver metastases].</a> Zentralblatt fur Chirurgie. 144 (3), 259-263 (2019).</li><li>Stattner, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evolution+of+surgical+microwave+ablation+for+the+treatment+of+colorectal+cancer+liver+metastasis:+Review+of+the+literature+and+a+single+centre+experience.">Evolution of surgical microwave ablation for the treatment of colorectal cancer liver metastasis: Review of the literature and a single centre experience.</a> Surgery Today. 45 (4), 407-415 (2015).</li><li>Takahashi, H., Berber, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Role+of+thermal+ablation+in+the+management+of+colorectal+liver+metastasis.">Role of thermal ablation in the management of colorectal liver metastasis.</a> Hepatobiliary Surgery and Nutrition. 9 (1), 49-58 (2020).</li><li>Livraghi, T., Meloni, F., Solbiati, L., Zanus, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Collaborative+Italian+Group+using+AMICA+system.+Complications+of+microwave+ablation+for+liver+tumors:+Results+of+a+multicenter+study.">Collaborative Italian Group using AMICA system. Complications of microwave ablation for liver tumors: Results of a multicenter study.</a> Cardiovascular and Interventional Radiology. 35 (4), 868-874 (2012).</li><li>Kassahun, W. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Unresolved+issues+and+controversies+surrounding+the+management+of+colorectal+cancer+liver+metastasis.">Unresolved issues and controversies surrounding the management of colorectal cancer liver metastasis.</a> World Journal of Surgical Oncology. 13, 61 (2015).</li><li>Birrer, D. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Multimodal+treatment+strategies+for+colorectal+liver+metastases.">Multimodal treatment strategies for colorectal liver metastases.</a> Swiss Medical Weekly. 151, w20390 (2021).</li><li>Stewart, C. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cytoreduction+for+colorectal+metastases:+liver,+lung,+peritoneum,+lymph+nodes,+bone,+brain.+When+does+it+palliate,+prolong+survival,+and+potentially+cure.">Cytoreduction for colorectal metastases: liver, lung, peritoneum, lymph nodes, bone, brain. When does it palliate, prolong survival, and potentially cure.</a> Current Problems in Surgery. 55 (9), 330-379 (2018).</li><li>Tanaka, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Outcome+after+hepatic+resection+versus+combined+resection+and+microwave+ablation+for+multiple+bilobar+colorectal+metastases+to+the+liver.">Outcome after hepatic resection versus combined resection and microwave ablation for multiple bilobar colorectal metastases to the liver.</a> Surgery. 139 (2), 263-273 (2006).</li><li>McNally, S. J., Parks, R. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Surgery+for+colorectal+liver+metastases.">Surgery for colorectal liver metastases.</a> Digestive Surgery. 30 (4-6), 337-347 (2013).</li><li>Robinson, J. R., Newcomb, P. A., Hardikar, S., Cohen, S. A., Phipps, A. I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Stage+IV+colorectal+cancer+primary+site+and+patterns+of+distant+metastasis.">Stage IV colorectal cancer primary site and patterns of distant metastasis.</a> Cancer Epidemiology. 48, 92-95 (2017).</li><li>Gavriilidis, P., Roberts, K. J., de'Angelis, N., Aldrighetti, L., Sutcliffe, R. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Recurrence+and+survival+following+microwave,+radiofrequency+ablation,+and+hepatic+resection+of+colorectal+liver+metastases:+A+systematic+review+and+network+meta-analysis.">Recurrence and survival following microwave, radiofrequency ablation, and hepatic resection of colorectal liver metastases: A systematic review and network meta-analysis.</a> Hepatobiliary &amp; Pancreatic Diseases International. 20 (4), 307-314 (2021).</li><li>McEachron, K. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Surgical+microwave+ablation+of+otherwise+non-resectable+colorectal+cancer+liver+metastases:+Expanding+opportunities+for+long+term+survival.">Surgical microwave ablation of otherwise non-resectable colorectal cancer liver metastases: Expanding opportunities for long term survival.</a> Surgical Oncology. 36, 61-64 (2021).</li><li>Qin, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+local+efficacy+and+influencing+factors+of+ultrasound-guided+percutaneous+microwave+ablation+in+colorectal+liver+metastases:+A+review+of+a+4-year+experience+at+a+single+center.">The local efficacy and influencing factors of ultrasound-guided percutaneous microwave ablation in colorectal liver metastases: A review of a 4-year experience at a single center.</a> International Journal of Hyperthermia. 36 (1), 36-43 (2019).</li><li>Abreu de Carvalho, L. F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Local+control+of+hepatocellular+carcinoma+and+colorectal+liver+metastases+after+surgical+microwave+ablation+without+concomitant+hepatectomy.">Local control of hepatocellular carcinoma and colorectal liver metastases after surgical microwave ablation without concomitant hepatectomy.</a> Langenbeck's Archives of Surgery. 406 (8), 2749-2757 (2021).</li><li>Akgul, O., Cetinkaya, E., Ersoz, S., Tez, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Role+of+surgery+in+colorectal+cancer+liver+metastases.">Role of surgery in colorectal cancer liver metastases.</a> World Journal of Gastroenterology. 20 (20), 6113-6122 (2014).</li><li>Francone, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Precoagulation-assisted+parenchyma-sparing+laparoscopic+liver+surgery:+Rationale+and+surgical+technique.">Precoagulation-assisted parenchyma-sparing laparoscopic liver surgery: Rationale and surgical technique.</a> Surgical Endoscopy. 31 (3), 1354-1360 (2017).</li><li>Fahy, B. N., Jarnagin, W. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evolving+techniques+in+the+treatment+of+liver+colorectal+metastases:+Role+of+laparoscopy,+radiofrequency+ablation,+microwave+coagulation,+hepatic+arterial+chemotherapy,+indications+and+contraindications+for+resection,+role+of+transplantation,+and+timing+of+chemotherapy.">Evolving techniques in the treatment of liver colorectal metastases: Role of laparoscopy, radiofrequency ablation, microwave coagulation, hepatic arterial chemotherapy, indications and contraindications for resection, role of transplantation, and timing of chemotherapy.</a> The Surgical Clinics of North America. 86 (4), 1005-1022 (2006).</li><li>Wada, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Efficacy+of+surgical+treatment+using+microwave+coagulo-necrotic+therapy+for+unresectable+multiple+colorectal+liver+metastases.">Efficacy of surgical treatment using microwave coagulo-necrotic therapy for unresectable multiple colorectal liver metastases.</a> OncoTargets and Therapy. 9, 937-943 (2016).</li><li>Lorentzen, T., Skjoldbye, B. O., Nolsoe, C. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Microwave+ablation+of+liver+metastases+guided+by+contrast-enhanced+ultrasound:+Experience+with+125+metastases+in+39+patients.">Microwave ablation of liver metastases guided by contrast-enhanced ultrasound: Experience with 125 metastases in 39 patients.</a> Ultraschall in der Medizin. 32 (5), 492-496 (2011).</li></ol>

The authors have no conflicts of interest to disclose.

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...

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&#160;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 intervention, cryotherapy, radiofrequency ablation, and microwave ablation to improve the survival rate of patients3. For unresectable colorectal cancer liver metastases, conventional chemotherapy, interventional therapy, and other treatment strategies have limited survival benefits for the vast majority of patients.
Surgery is the gold standard for liver metastases from colorectal cancer, with a 5 year survival rate of 40%. Only 20%-30% of patients with colorectal liver metastases can benefit from surgical treatment, and most patients with unresectable colorectal liver metastases experience limited benefit from traditional conservative treatment4. An important method in the treatment of colorectal cancer liver metastases is thermal ablation, including microwave ablation and radiofrequency ablation; these two techniques induce cell death through coagulation necrosis caused by local hyperthermia. The main indications of thermal ablation include (i) unresectable liver lesions; (ii) combination with hepatectomy; (iii) patients with severe comorbidities or poor performance status (PS); (iv) small (&#60;3 cm) solitary lesions otherwise requiring segmentectomy; and (v) patient preference5. Among them, microwave ablation (MWA) is a safe and effective treatment that can prolong the survival of patients. It has a wide range of active heating areas and does not depend on electrical conduction in the tumor tissue. This energy transfer is not limited by tissue scorching. Compared with radiofrequency ablation, microwave ablation has a higher temperature in the tumor tissue, shorter treatment time, and larger treatment range6.
Multiple intrahepatic metastases often occur in colorectal cancer liver metastases. In conventional treatment, chemotherapy, immunotherapy, interventional therapy, microwave therapy, radiofrequency ablation, and other methods can improve the survival rate of patients. The 5 year survival rate is 50%, but the survival rate is still low7. Surgical resection is still an important method for the treatment of liver metastases. Due to multiple liver metastases, small residual liver volume, postoperative bleeding, bile leakage, and inflow or outflow tract obstruction, which lead to the risk of liver failure, the surgical resection of multiple liver metastases is difficult. Three-quarters of patients are diagnosed with unresectable liver metastases8. Laparoscopic hepatectomy combined with microwave ablation in the treatment of colorectal cancer liver metastases can avoid the small amount of residual liver limiting the operation, reduce the adverse reactions of systemic chemotherapy, and overcome the electrical conduction barrier of radiofrequency ablation, thereby improving the success rate of surgery, prolonging the survival time of patients, and achieving a better prognosis of colorectal cancer liver metastases3,9.
This protocol describes the precision treatment of laparoscopic hepatectomy combined with microwave ablation for tumors &#60;3 cm, occult liver metastases, and multiple liver metastases with positioning using laparoscopic ultrasound.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>0.9% sodium chloride solution</td>
			<td>Foshan Shuanghe Commercial Co., Ltd</td>
			<td>H20013095</td>
			<td>Dilute antibiotics, irrigate.</td>
		</tr>
		<tr>
			<td>2-0 polyglactin 910 sutures</td>
			<td>Johnson &#38; Johnson Medical Devices</td>
			<td>W8400</td>
			<td>Close the Trocar hole.</td>
		</tr>
		<tr>
			<td>3 D laparoscopic</td>
			<td>STORZ</td>
			<td>26605BA</td>
			<td>Surgical treatment under direct vision, minimally invasive</td>
		</tr>
		<tr>
			<td>Absorbable Hemostat</td>
			<td>ETHICON</td>
			<td>1962</td>
			<td>wound hemostasis</td>
		</tr>
		<tr>
			<td>BiClamp E Lap</td>
			<td>ERBE Elektromedizin GmbH</td>
			<td>20195-136</td>
			<td>Intraoperative wound hemostasis</td>
		</tr>
		<tr>
			<td>Cefoperazone Sulbactam Sodium</td>
			<td>Pfizer Pharmaceuticals Ltd</td>
			<td>H20020597</td>
			<td>infection prevention</td>
		</tr>
		<tr>
			<td>Laparoscopic ultrasound probe</td>
			<td>HITACHI</td>
			<td>ALOKA-UST5418</td>
			<td>Intraoperative localization of liver metastases</td>
		</tr>
		<tr>
			<td>LIGACLIP Multiple Clip Applier and Ligating Clips</td>
			<td>Ethicon Endo - Surgery, LLC</td>
			<td>ER320</td>
			<td>Clamp tiny blood vessels and bile ducts</td>
		</tr>
		<tr>
			<td>Microwave ablation System</td>
			<td>Nanjing Yigao Microwave System Engineering Co., Ltd, China</td>
			<td>ECO-100A110</td>
			<td>Microwave ablation of liver metastases</td>
		</tr>
		<tr>
			<td>Polymer ligation clips</td>
			<td>Teleflex Medical, USA</td>
			<td>Hem-lock544233</td>
			<td>Clipping of broken ends of blood vessels and bile ducts</td>
		</tr>
		<tr>
			<td>Silica gel drainage tube</td>
			<td>BAINUS MEDICAL</td>
			<td>YY-Fr16</td>
			<td>Drainage of peritoneal fluid</td>
		</tr>
		<tr>
			<td>Ultrasonic knife</td>
			<td>Johnson &#38; Johnson Medical Devices</td>
			<td>HAR36</td>
			<td>Tissue cutting, microvascular hemostasis</td>
		</tr>
	</tbody>
</table>

application of laparoscopic hepatectomy combined with intraoperative microwave ablation in colorectal cancer liver metastasis

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 &gt;40% in cirrhotic patients and &gt;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.

For patients with liver metastases from past colorectal cancer, patients with unilateral liver metastases, or patients with few liver metastases can undergo surgical resection and obtain a good prognosis. Nevertheless, in patients with unresectable colorectal cancer with multiple liver metastases in both lobes, conservative treatment has a poor prognosis and a low 5 year survival rate. However, hepatectomy combined with microwave ablation can further improve the survival rate of patients and achieve a good prognosis comp...

Watch this Scientific Journal Video about Application of Laparoscopic Hepatectomy Combined with Intraoperative Microwave Ablation in Colorectal Cancer Liver Metastasis at JoVE.com

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

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 &lt;3 cm, reduce postoperative complications, and accelerate the postoperative rehabilitation of patients.

Laparoscopic hepatectomy is a common treatment for colorectal cancer liver metastasis. Previously, a sufficient number of functional liver masses had to ...

Surgical resectioning combined with microwave ablation provides a safe and effective method for multiple colorectal cancer liver metastases, especially when the residual liver volume is insufficient. This technique simplifies the operation procedures, reduces the risk of complications such as bleeding and bile leakage, shortens the operation time, and accelerates the postoperative recovery. In addition to colorectal cancer liver metastases, this method can also be applied to multiple primary liver cancer or other secondary liver tumors.It's recommended to master the basic theory of liver ultrasound and practice portal vein puncture, guided by laparoscopic ultrasound before using this technique. Insert a 12 centimeter trocar into the navel and abdominal cavity for erasion. Place five centimeter trocars under the xiphoid process and below the costal margin of the right midclavicular line.Examine the cavity and the parenchymal organs by placing the naval trocar into the laparoscope. Using an ultrasonic knife, separate the round and flacid form ligaments attached to the abdominal wall and liver diaphragm. After intravenous injection of the contrast agent, place the laparoscopic probe into the abdominal cavity.Then examine the liver by moving the probe over the tissues. Locate the contrast defined metastatic tumors in the S5 and S7 liver segments using ultrasound. Next, insert two five centimeter trocars to aid in the procedure.Confirm the location of the tumors using ultrasound probe. Remove the connecting tissues using an ultrasound scalpel. Expose the hepatic pedicles between segments two and three and sever the branch of the umbilical fissure vein.Then start dissecting the parenchyma of the left lateral lobe using an ultrasonic scalpel. Continue the dissection through the entire lobe. Then sever the left lateral lobe.Collect the dissected lobe. Then detach the liver by removing the surrounding connecting tissue. Next, using the laparoscopic ultrasound, locate the tumor boundaries and mark the liver surface.Detect the location of liver metastases using an ultrasound probe and mark the location keeping less than one centimeter of margin from the tumor. Insert the microwave ablation needle into the abdominal cavity through the percutaneous puncture. Insert the needle into the center of the tumor under the laparoscopic probe guidance and perform microwave ablation.Remove the needle after complete ablation using an ultrasonic scalpel, electro coagulate the liver parenchyma sections. Continue the electrocoagulation until the tumor tissue is excised. Collect the tissue and place it in the bag.Place a hemostatic gauze. Then clean the abdominal cavity by rinsing the tissue and removing the hemostatic gauze. Release the umbilical fissure vein and remove the tissue debris.Finally place the drainage tube. The surgery had a runtime of 130 minutes. Liver ablation was successful at under 55 watts for five minutes, resulting in low intraoperative blood loss of 50 milliliters.Postoperative complications were not observed, which resulted in patient discharge eight days after the surgery. Laparoscopic ultrasound scan of the whole liver is very important after the injection of contrast agent. It may reveal lesions that are difficult to find in preoperative imaging such as MR or ct.

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266 Görüntüleme.  Sun Yat-sen University. Mikrodalga ablasyon ile kombine cerrahi rezeksiyon, özellikle rezidüel karaciğer hacmi yetersiz olduğunda, çoklu kolorektal kanser karaciğer metastazları için güvenli ve etkili bir yöntem sağlar. Bu teknik, ameliyat prosedürlerini basitleştirir, kanama ve safra kaçağı gibi komplikasyon riskini azaltır, ameliyat süresini kısaltır ve ameliyat sonrası iyileşmeyi hızlandırır. Kolorektal kanser karaciğer metastazlarına ek olarak, bu yöntem birden fazla primer karaciğer...