Scientific Abstracts: Liver Metastases and Pancreas
Objective: During percutaneous computed tomography (CT) guided liver ablation, decent visualization of both the lesion and the ablation zone is indispensable to achieve an efficacious treatment and improve oncological outcomes. This study aimed to assess the value of hepatic artery catheter guidance in terms of local disease control for patients undergoing percutaneous radiofrequency (RFA) or microwave ablation (MWA) of colorectal liver metastases (CRLM).
Methods: This IRB-exempted single-center comparative, retrospective analysis analyzed the data of 108 patients treated for CRLM between January 2009 and May 2019 using either CT hepatic arteriography (CTHA) or conventional CT fluoroscopy. The local tumor progression-free survival (LTPFS) was assessed using univariate and multivariate Cox proportional hazard regression analyses to correct for potential confounders.
Results: In 156 procedures (42 CT fluoroscopy; 114 CTHA), 260 liver metastases were treated with percutaneous ablation (76 RFA; 184 MWA). There were no complications related to the trans-arterial procedure. CTHA proved superior to CT fluoroscopy regarding LTPFS (18/202 [8.9%] vs. 19/58 [32.8%]; P <0.001, respectively). CTHA vs. CT fluoroscopy (HR 0.28 [95% CI 0.15-0.54]; P < 0.001), MWA vs. RFA (HR 0.52 [95% CI 0.24-1.12]; P = 0.094), and larger tumor diameters (HR 1.04 [95% CI 1.02-1.07]; P = 0.001) were positive predictors for a longer LTPFS. Multivariate analysis revealed that CTHA vs. CT fluoroscopy (HR 0.45 [95% CI 0.21-0.96]; P = 0.040) was associated with a superior LTPFS.
Conclusions: At the cost of adding procedure-time and marginal patient-burden, transcatheter CTHA guided ablation was associated with a superior LTPFS compared to conventional CT fluoroscopy. Hence, CTHA should be favored over CT fluoroscopy as it reduces the number of repeat ablations required without adding risk.