Minimally invasive treatment for liver and lung metastases in colorectal cancer.

the patient A 59 year old woman had an anterior resection for pri‑ mary Dukes's C rectal carcinoma in 2004 followed by adjuvant chemotherapy. Two years later, on routine com‑ puted tomography surveillance, she was found to have liver (fig 1) and lung (fig 2) metastases. surveillance after resection of primary colorectal cancer Surveillance is indicated in patients with Dukes's B or Dukes's C colorectal carcinoma who are potential can‑ didates for further therapeutic intervention. The optimal surveillance strategy is a matter of debate. 1‑3 An ongoing trial (FACS) is looking at the cost effectiveness of intensive follow‑up or no follow‑up in patients with successfully resected colorectal cancer (www.facs.soton.ac.uk/). Cur‑ rently, most centres opt for computed tomography scans at six or 12 monthly intervals for the first two or three years, combined with regular measurements of serum carcinoembryonic antigen. Because the liver metastases were centrally located in our patient, surgery would have involved removal of three quarters of the liver, followed by pulmonary lobectomy for the lung metastasis. Liver resection and pulmonary resection are associated with a small increase in mortality—less than 5% for liver resection and less than 2% for pulmonary resection—and combined liver and lung resection has been reported to improve sur‑ vival for patients with metastases from colorectal cancer. 4 However, in light of the substantial morbidity (<37%) associated with major liver surgery and the need for two surgical procedures, the patient opted for radiofrequency ablation to both areas (fig 3). Our standard investigation for radiofrequency ablation is high quality, contrast enhanced, multidetector com‑ puted tomography, with occasional positron emission tomography‑computed tomography or liver magnetic resonance imaging where specific questions need to be answered. These last two tests are used more often when investigating patients for liver resection; this is warranted given that resection is a more invasive and expensive procedure. The liver lesions were ablated under general anaes‑ thesia using an array of three water cooled electrodes. One month later, the patient had ablation of the lung metastasis, which was performed under conscious seda‑ tion (midazolam and fentanyl) with a single water cooled electrode. After ablation, she received systemic chemo‑ therapy with oxaliplatin and fluorouracil. Outcome Follow‑up scans performed four to five months after abla‑ tion show absent enhancement at the treated sites in the liver and lung consistent with ablated tumour (figs 4, 5). What is radiofrequency ablation? Radiofrequency ablation is a minimally invasive, image …