Karaciğer Metastazlarında Ultrason Eşliğinde Yapılan Mikrodalga Ablasyon Tedavisi Sonrası Gelişen Lokal Nüksün Kapsül ve Ablasyon Traktı ile İlişkisi ve Ki-67 indeksinin etkisi

Amaç: Çalışmamızda karaciğer metastazlarında ultrason eşliğinde yapılan mikrodalga ablasyon tedavisi sonrası gelişen lokal nüksün karaciğer kapsülü ve ablasyon traktı ile ilgili özelliklerinin değerlendirlmesi amaçlanmıştır. Yöntemler: Şubat 2016 ile Aralık 2019 tarihleri arasında mevcut karaciğer metastazına US rehberliğinde perkutan mikrodalga abalasyon tedavisi yapılan 101 olgu retrospektif olarak değerlendirildi. Toplam 32 lokal nükse sahip ablate lezyonu bulunan 19 hasta çalışmaya dahil edildi. Metastazların histopatolojik tipleri, ablasyon öncesi özellikleri ve ablasyon işlemine ait bilgiler not edildi. Tümörün boyutları ve tümör ile karaciğer kapsülü arasındaki en kısa mesafe ölçüldü. Lokal nüksün karaciğer kapsülüne ve ablasyon tarktına göre tarafı ve yerleşimi ile şekil özellikleri değerlendirildi. Bulgular: Ortanca lokal nükssüresi 8.46±4.54 ay (3-20 aralığında) olarak bulundu. Hasta ve lezyon bağımlı lokal nüks oranları sırasıyla 19% ve 20% idi. Parankim içi yerleşimli lezyonlara ait lokal nükslerin tümü ablasyon traktının ucu ya da yanında yerleşimli olarak bulundu ve bu ilişki istatistiksel olarak anlamlıydı (p=0.035). Damar yakınlığı ile lokal nüksün şekli ve lokal nüksün tarafı ile şekli arasında istatistiksel olarak anlamlı ilişki saptanmadı (sırasıyla p=0.704 ve 0.683). Sonuç: Çalışmamızda parankimal yerleşimli lezyonlardan gelişen lokal rekürrensin hepsinin ablasyon traktının uç ve yan kesimlerinden geliştiği ortaya konulmuştur. Ayrıca lokal rekürrensin karaciğer kapsülü ve ablasyon traktı ile ilişkili bir takım özellikleri ve bu bulguların birbiri ile ilgili ilişkileri ortaya konuldu.

Capsule and Ablation Tract Related Features of Local Recurrence in Ultrasound Guided Microwave Ablation of Liver Metastases

Aim: We aimed to evaluate the capsule and ablation tract related features of local recurrence after ultrasound(US) guided percutaneous microwave ablation (MWA) of the liver metastases independently.Methods: Between February 2016 and December 2019, 101 patients with US-guided percutaneous MWA of theliver metastases were analyzed. Nineteen patients having thirty-two ablated lesions with local recurrence (LR)were included in the study. Histopathologic type of tumor, pre-ablative features of the lesions and the ablationprocedure data were noted. Tumor size, the closest distance between the lesion and the liver capsule wasmeasured. The site of LR related to the liver capsule and related to ablation tract and the shape of the LR werenoted.Results: The median time of LR was 8.46±4.54 months (range, 3-20). The patient (n=19) and the ablated lesion(n=32) depended LR rates were 19% and 20% respectively. All LR of the parenchymal localized metastaticlesions originated from either tip or the side of the ablation tract and this relationship was found as statisticallysignificant (p=0.035). No statistically significant relationship was found between vessel closeness and shape ofLR (p=0,704) and between the site and the shape of LR (p=0.683).Conclusion: We demonstrated that the LR arising from parenchymal localized metastatic lesions were fromeither the tip or the side of the ablation tract. We also defined some features of LR related to the ablation tractand liver capsule independently.

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