1000 consecutive ablation sessions in the era of computer assisted image guidance – Lessons learned

Abstract

Background: Ablation therapies for tumours are becoming more used as ablation modalities evolve and targeting solutions are getting better. There is an increasing body of long-term results challenging resection and proving lower morbidities and costs. The aim of this paper is to share the experiences from a high-volume centre in introducing computer assisted targeting solutions and efficient ablation modalities like microwave generators and irreversible electroporation. Material and methods: One thousand consecutive treatments in one high-volume centre were evaluated retrospectively from prospectively collected data. Results: The purpose of this paper is to present the benefits of going into computer assisted targeting techniques and microwave technology; pitfalls and overview of outcomes. The main target organ was the liver and the main indications were ablation of hepatocellular carcinomas and colorectal liver metastases. With the assistance of computer assisted targeting the local recurrence rate within 6 months has dropped from 30 to near 10%. The survival of patients with hepatocellular carcinoma and colorectal liver metastases is not worse if the tumour can be retreated after a local recurrence. Multiple colorectal liver metastases can be treated successfully. Discussion: The incorporation of computer assisted targeting technologies for ultrasound-, ct guided- and laparoscopic tumour ablation has been very successful and without a noticeable learning curve. The same is true for switching from radiofrequency energies to microwave generators and irreversible electroporation. Conclusion: It is well worthwhile upgrading ablation and targeting technologies to achieve excellent and reproducible results and minimizing operator dependency. Keywords: Microwave, IRE, RF, Ablation, Liver, Pancreas, Kidney, Lung, Hepatocellular carcinoma, Renal cell carcinoma, Colorectal liver metastases, Stereotactic navigation, Ultrasound, Fused ultrasound, Jet ventilation