RADIOFREQUENCY THERMOABLATION - CURRENT POSITIONS OF THE METHOD

O.I. ZHAVORONKOVA, V.A. VISHNIEVSKI, D.A. IONKIN, O. MELEKHINA, A.B. SHURAKOVA

Institute of Surgery named after A.V. Vishnievski, Moscow, RUSSIA

Improvement of theresults of treatment of patients with focal hepatic neoplasm from the point of view of surgical radicalism and within the optimization of oncologic aid.

Materials and Methods: radiofrequency ablation (RFA)has been introduced in the Institute of Surgery named after A.V. Vishnevsky, since 2002, The method was performed with the application of Radionics Cool-Tip Ablation System device and a set of water-cooled electrodes of a single or cluster type, both as a directional intervention to focal neoplasms of primary and secondary origin in 132 patients, and at the stages of separation and/or treatment of a cut during liver resection of various sizes in 49 patients with metastases: colorectal cancer - 27, ovarian cancer - 3, renal cancer - 1, gastrointestinal stromal tumor – in 1, as well as primary hepatic cancer - in 14 and parasitic liver lesions - in 3.

In local tumor destruction the total number of sessions constituted 231 - 80% of interventions - performed percutaneously; first time – for the treatment of newly diagnosed metastases, repeatedly – to influence on focuses of continuing growth and / or residual nodes. In 20% of the observations RFA was performed at the intraoperative stage after the removal of parenchymal lesions on the remaining segments of the liver. The positioning of the electrodes was performed under ultrasound guidance, the optimal complex of studies for the assessment of the adequacy of the RFA is a combination of ultrasound and MRT, the latter shall be performed in the first 24 hours, in their dynamic observation their alternations and supplement by one another is possible.

The results of RFA in focal liver formations were observed in 124 patients within the periods ranging between 3 and 70 months. with the assessment of 1, 2, 3, 4, 5-year survival rate – there was revealed its significant increase. Survival median in a most representative group with secondary colorectal liver constituted 31 months. The use of RFA method for hepatic resection provided reliable parenchymal hemostasis and cholestasis, sufficient radicalism was ensured.

Complications occurring during RFA: fluid accumulations, abscesses, exudative pleuritises were removed by minimally invasive puncture-drainage interventions in the postoperative period.

Date: 2014-12-28; view: 809