A 76-year-old patient who underwent emergency surgery for perforated cecum tumor affecting the terminal ileum.
Personal history included ischemic heart disease with AMI and coronary bypass grafting for 13 and 6 years, respectively.
He underwent a right hemicolectomy and resection of 15 cm of ileum with reconstruction of the transit through an ileocolic anastomosis.
We observed the presence of liver metastases in segment 8 with a size of 4 cm. A second intervention was required 4 days later due to intra-abdominal abscess.
The pathological study showed a well differentiated adenocarcinoma with 17 nodes free of tumor (T4N0M1).
Postoperative CT showed a 3.5 cm solid nodular lesion in segment 8 of the liver.
Postoperative MQ was performed with FOLFOX with a decrease in the size of the lesion to 2.5 cm. Six months after the primary tumor intervention, it was decided to perform a laparoscopic RF for liver metastases, given the high surgical risk.
1.
The procedure was performed under general anesthesia with the patient in the supine position.
Placement of access to the abdominal cavity and optics was at the epigastric level.
An 11 mm mesh was placed below the costal margin.
The 7.5 Mhz portable laparoscopic ultrasound transducer was placed through the 11 mm mesh. No other metastatic lesions were observed on ultrasound.
Under ultrasound and laparoscopic control, the electrode was inserted in the center of the lesion and its ablation was performed at a target temperature of 105 oC, a treatment time of 6 minutes, and a correct intraheptic pathway ablation of 150 oC.
The RF electrode used was 25 cm long and ablation diameter was 4 cm. The lesion became hyperechogenic after ablation and no residual lesion was observed.
There were no postoperative complications and the hospital stay was one day.
One month after the treatment with radiofrequency ablation a hypodense lesion was detected, which was compatible with tumor necrosis.
