Electrolysis and other local ablative treatments for non-resectable colorectal liver metastases

Clinical procedure for intraocular electrochemical lysis during endoresection

Optimal clinical approaches to the treatment of large intraocular lesions located in the posterior pole of the eye remain controversial. In our opinion, the introduction of innovative techniques into the clinical practice of vitreoretinal surgery professionals as well as the implementation of new techniques designed to destroy tumour tissue will make endoresection one of the most promising alternative approaches to choroidal melanoma management, providing an encouraging high-potential eye-saving treatment option in the future. However, in view of a small number of treated cases and a short follow-up period, further research studies are required to evaluate the effectiveness of the electrochemical lysis procedure during endoresection.

Electrolysis - a new method of renal ablation?

OBJECTIVE

• To present a novel method of renal ablation using direct current electrolysis, using a porcine model to assess the safety and efficacy of the technique.

MATERIALS AND METHODS

• In all, 20 anaesthetised pigs were used, after receiving ethical approval. The pigs were housed and managed in accordance with Institute of Medical and Veterinary Science guidelines. • A single 6 F catheter incorporating cathode and anode was inserted directly into the renal parenchyma via a loin incision. A direct current of 100 mA was applied for varying times. • Several treatments were performed in each pig and a total of 72 treatments were analysed. • The pigs were recovered and observed for 3 days with an analysis of electrolytes and creatinine after ablation. The pigs were humanely killed at 3 days and the kidneys submitted for histological analysis.

RESULTS

• Complete tissue destruction was seen in the area of kidney treated with no viable cells. • A sharp line of demarcation was noted between normal renal parenchyma and the area of coagulative necrosis. The area of tissue ablation was reliably predicted from the duration of application of the electrolytic current. • One pig developed a secondary haemorrhage.

CONCLUSIONS

• Renal electrolysis is a new method of focal renal ablation. The procedure may be carried out using a fine ablation catheter (6 F) allowing for the development of minimal intervention treatment of small renal masses. • This study shows the technique to be effective and safe. As with other renal ablative techniques there is a small risk of postoperative haemorrhage.

Electrochemical lysis of an intraocular tumour using a combination of electrode placements

The objective of this experimental study was to develop a new combination technique for electrode placement and the histomorphological evaluation of its effectiveness for the electrochemical lysis of large intraocular tumours.

Role of FDG-PET in surgical management of patients with colorectal liver metastases

BACKGROUND

[(18)F]-fluorodeoxyglucose positron emission tomography (FDG-PET) is reported to change the management in 20-56% of patients with recurrent or metastatic colorectal cancer. It is not clear if FDG-PET has a role in all such patients or only a subgroup. The aim of the present study was to assess the influence of FDG-PET on the surgical management of patients with known or suspected colorectal liver metastases.

METHODS

Patients undergoing FDG-PET for investigation of known or suspected colorectal liver metastases were identified from a South Australian database. Case notes were reviewed retrospectively to determine the influence of FDG-PET findings on patient management. Findings from FDG-PET scanning were compared with findings from conventional diagnostic investigations and operative findings.

RESULTS

Overall, in four of 16 patients (25%) management was influenced by FDG-PET findings. FDG-PET altered management in four of eight (50%) patients with non-diagnostic liver lesions on computed tomography (CT) or with elevated carcinoembryonic antigen levels but no liver lesion on CT. In all eight patients with CT diagnosed resectable liver metastases, the addition of FDG-PET did not influence the management.

CONCLUSIONS

The findings support the use of FDG-PET in the assessment of selected patients with suspected colorectal liver metastases and equivocal findings on conventional diagnostic investigation.

Management of the pelvic recurrence of rectal cancer with radiofrequency thermoablation: a case report and review of the literature

INTRODUCTION

The results of rectal cancer surgery are limited by the development of local recurrence (LR) that represents a great challenge to the surgeon. In the presence of unfavourable conditions for performing a curative operation, various forms of palliative treatment are indicated to control the patient's symptoms and the disease's complications. Recently, radiofrequency thermoablation (RFTA) has become a complimentary alternative therapy for malignant inoperable liver tumours. The present paper reports the use of RFTA in the management of pelvic recurrence of rectal adenocarcinoma.

CASE REPORT

Fourteen months after abdominoperineal resection, a 32-year-old woman began to complain of progressive pelvic and lumbar pain. A large pelvic mass was found and serum CEA was elevated (66.4 ng/ml) at that time. Due to the dimensions of the presacral tumour (8 x 5 x 4 cm3) and the associated refractory pain, the patient underwent RFTA of the recurrent disease. Under epidural anaesthesia, a computed tomography-guided percutaneous needle electrode was introduced into the tumour. Although the procedure provided immediate pain control, the patient developed an intestinal obstruction 3 months later. This complication required surgical treatment to release adherences from the necrosed tumour.

CONCLUSION

Apart from this complication, RFTA allowed prolonged relief of the pelvic pain and improved quality of life. Faced with an unresectable pelvic recurrence, RFTA proved to be a viable option for controlling pain, although a relatively high cost and eventual complications may limit its use.

The lack of a systemic inflammatory response syndrome supports the safety of pancreatic electrolysis: experimental studies

BACKGROUND

Per-ductal pancreatic electrolysis is a new minimally invasive ablation treatment. Possible applications include tumor debulking and treatment of chronic pancreatitis. Both solid organ ablation and pancreatitis are associated with the risk of an overwhelming systemic inflammatory response syndrome (SIRS) and multiorgan failure. TNF-alpha and IL1-beta are important cytokine mediators of this response. The aim of this study was to measure the circulating levels of IL1-beta and TNF-alpha following pancreatic electrolytic ablation as a marker of the risk of SIRS complicating per-ductal pancreatic electrolysis.

METHODS

Serum TNF-alpha and IL1-beta were measured in six treatment and six control pigs before and after laparotomy and pancreatic electrolytic ablation via a per-ductal approach.

RESULTS

There was no significant rise in serum TNF-alpha and IL1-beta in association with per-ductal pancreatic electrolysis.

CONCLUSIONS

This study supports the evidence that per-ductal electrolysis is a safe procedure with potential for palliative treatment of pancreatic cancers.

Electrolytic liver ablation is not associated with evidence of a systemic inflammatory response syndrome

Background

Local ablation has been proposed for treatment of liver tumours. Cryoshock, a variant of the systemic inflammatory response syndrome (SIRS), is a potentially fatal complication of cryoablation caused by systemic release of necrotic breakdown products from ablated liver. The proinflammatory cytokines tissue necrosis factor (TNF) α and interleukin (IL) 1 are important mediators of this response. This study assessed the risk of SIRS complicating electrolytic liver ablation by measuring circulating levels of inflammatory cytokines, other inflammatory markers and clinical markers of organ function.

Methods

Electrolytic liver ablation was performed in 16 pigs and four pigs served as controls. Platelet count, and serum levels of urea, creatinine, liver enzymes, C-reactive protein (CRP), TNF-α and IL-1β were measured before treatment and for 72 h after the procedure.

Results

There were significant dose-related increases in CRP and alanine aminotransferase levels with liver electrolysis. There was no significant derangement in renal function or platelet count following ablation. A rise in serum TNF-α and IL-1β levels was not associated with liver electrolysis.

Conclusion

There was no evidence of organ failure or significantly raised levels of proinflammatory cytokines as a result of liver electrolysis, suggesting that this is a safe procedure for liver ablation.