Outcomes after resection and/or radiofrequency ablation for recurrence after treatment of colorectal liver metastases

Background: Repeat liver resection for colorectal liver metastases (CRLMs) is possible in a limited number of patients, with radiofrequency ablation (RFA) as an alternative for unresectable CRLMs. The aim of this study was to analyse survival rates with these interventions. Methods: This was a database analysis of patients who underwent first and repeat interventions for synchronous and metachronous CRLMs between 2000 and 2013. Descriptive and survival statistics were calculated. Results: Among 431 patients who underwent resection or RFA for CRLMs, 305 patients developed recurrences for which 160 repeat interventions (resection and/or RFA or ablative radiotherapy) were performed. In total, after 707 first or repeat interventions, 516 recurrences (73.0 per cent) developed, of which 276 were retreated curatively. At the time of first intervention, independent risk factors for death were lymph node-positive primary tumour (hazard ratio (HR) 1.40; P = 0.030), more than oneCRLM(HR 1.53; P = 0.007), carcinoembryonic antigen level exceeding 200 ng/ml (HR 1.89; P = 0.020) and size of largest CRLM greater than 5 cm (HR 1.54; P = 0.014). The 5-year overall survival rates for liver resection and percutaneous RFA as first intervention were 51.9 and 53 per cent, with a median overall survival of 65.0 (95 per cent c.i. 47.3 to 82.6) and 62.1 (52.2 to 72.1) months, respectively. Conclusion: RFA had good oncological outcomes in patients with unresectable CRLMs. Radiofrequency ablation is progressively more applied with each additional intervention

Radiofrequency Ablation of Hepatic Metastases from Thyroid Carcinoma

Background: Radiofrequency ablation (RFA) is performed for various types of liver tumors. It might also have a role in the palliative treatment of liver metastases from thyroid carcinoma. Summary: Three patients with liver metastases of thyroid carcinoma were retrieved from our database of 125 patients who had been treated with RFA for liver tumors. In all three patients, the metastases were a sign of widespread disease, and several other treatment modalities had been performed earlier. Two patients had metastases from medullary thyroid carcinoma and had severe diarrhea. The third patient had a rapidly progressive metastasis of a follicular thyroid carcinoma. The aim of the treatment was cytoreduction with amelioration of symptoms (n = 2) and debulking with increased sensitivity for subsequent I-131 treatment. The ablation was performed via laparotomy (n = 1), laparoscopically (n = 1), or percutaneously (n = 1). One patient experienced superficial burn wounds after a long-lasting RFA procedure. Severity of symptoms was reduced significantly after RFA for a prolonged period of time. RFA induced partial tumor necrosis because of hypervascularization of the tumor in one patient. After arterial embolization the second RFA treatment induced total tumor necrosis. Local recurrences at the site of the ablated liver metastases were not encountered during follow-up. Conclusions: RFA is a useful treatment modality in patients with liver metastases from thyroid carcinoma. It should be considered an adjunct to other types of treatment or for those patients in whom more regular treatment modalities are not effective or possible or are associated with increased risks

Emergency Bleeding Control Interventions After Immediate Total-Body CT Scans in Trauma Patients

Background: Immediate total-body CT (iTBCT) is often used for screening of potential severely injured patients. Patients requiring emergency bleeding control interventions benefit from fast and optimal trauma screening. The aim of this study was to assess whether an initial trauma assessment with iTBCT is associated with lower mortality in patients requiring emergency bleeding control interventions. Methods: In the REACT-2 trial, patients who sustained major trauma were randomized for iTBCT or for conventional imaging and selective CT scanning (standard workup; STWU) in five trauma centers. Patients who underwent emergency bleeding control interventions following their initial trauma assessment with iTBCT were compared for mortality and clinically relevant time intervals to patients that underwent the initial trauma assessment with the STWU. Results: In the REACT-2 trial, 1083 patients were enrolled of which 172 (15.9%) underwent emergency bleeding control interventions following their initial trauma assessment. Within these 172 patients, 85 (49.4%) underwent iTBCT as primary diagnostic modality during the initial trauma assessment. In trauma patients requiring emergency bleeding control interventions, in-hospital mortality was 12.9% (95% CI 7.2–21.9%) in the iTBCT group compared to 24.1% (95% CI 16.3–34.2%) in the STWU group (p = 0.059). Time to bleeding control intervention was not reduced; 82 min (IQR 5–121) versus 98 min (IQR 62–147), p = 0.108. Conclusions: Reduction in mortality in trauma patients requiring emergency bleeding control interventions by iTBCT could not be demonstrated in this study. However, a potentially clinically relevant absolute risk reduction of 11.2% (95% CI − 0.3 to 22.7%) in comparison with STWU was observed. Trial registration: ClinicalTrials.gov: NCT01523626