Trans-metastasis hepatectomy: results of a 21-case study.

Aim: The aim of this study was to report the feasibility and efficiency of a new approach, called post-RF trans-metastasis hepatectomy (PRFTMH). This technique consists in using RF to first ablate an ill-located liver metastasis (LM) along the planned hepatectomy resection line, the only one possible for volumetric reasons, and then to perform the hepatectomy passing via this initially ablated LM.

Material And Methods: Twenty-one patients were treated with PRFTMH between January 2000 and May 2004. Thirteen of them had a primary colorectal tumour, four had a primary endocrine tumour and four had miscellaneous primaries. The mean number of LMs per patient was 13.8 (10.7 for primary colorectal tumours and 22.2 for primary endocrine tumours). Pre-operative hypertrophy of the future remaining liver was obtained by selective portal vein embolisation in 11 patients.

Results: One patient died post-operatively (4.7%) and five developed complications (24%). No local recurrence has occurred at the site of PRFTMH after a median follow-up of 19.4 months (range: 47-7), demonstrating the efficacy of this technique. All patients, except the patient who died post-operatively, are currently alive, and the median survival rate has not yet been attained, after a median follow-up of 19.4 months.

Conclusion: PRFTMH combining RF ablation and trans-metastasis hepatectomy is a new and safe technique, allowing a curative approach to be proposed to some patients with unresectable bilateral LMs.