Ablation in segment VI close to portal vein and vena cava

Navigated ablation of a difficultly located lesion in segment VI of the liver under the glisson capsule between the portal vein and the vena cava. Ablation was the only possible treatment because the patient refused chemotherapy. No vessels damaged during intervention. Complete ablation of the lesion on the control CT. 

Case_Fribourg_December_2019_Overview-1
 
1. Planning scan of the intervention (MPR)
2. Validation of needle trajectory and needle position
3. CT scan after ablation with complete tumor treatment in axial, sagittal and coronal view
4. CT scan directly after ablation with ablation zone (hypodense) and planned safety margin (yellow)
 

Name: Dr. Carlo Tappero 


Institution: HFR Fribourg, Switzerland


Patient age and sex:  58 years, male


Initial condition:

Moderately differentiated adenocarcinoma of the lower rectum, classified as cT3 uN1 cM0, mutated KRAS gene, diagnosed quarter 2, 2018
  • MRI of the pelvis, quarter 2, 2018: Tumour of the lower rectum, located about 5.5 cm from the anal edge and 2 cm from the upper part of the anal sphincter. The tumour infiltrates the right perirectal fat, which is classified as T3 N+ in the lower pole and is located 2 cm above the upper part of the anal sphincter
  • Post-Radiochemotherapy status with Xeloda, quarter 2, 2018
  • Ultra-low anterior post-resection status by laparotomy with manual colo-anal anastomosis and protective ileostomy, quarter 3, 2018, complicated by the conservatively treated anastomosis load. Postoperative stage ypT3 ypN1c (tumour deposition) (0/25) R0 V0 pN0 R0. Tumour regression degree TR3
  • Status after 9 cycles of palliative chemotherapy with FOLFOX (refusal of treatment with Avastin), quarter 4, 2018 to quarter 1 2019 followed by 6 cycles of chemotherapy with 5-FU / Leucovorin until quarter 2, 2019

Treatment: 
  • Decision for a navigated procedure with CAS-One because the lesion is located in segment VI of the liver, under the glisson capsule and between the portal vein and the vena cava. Although the lesion was clearly identifiable under ultrasound, no access could be planned without damaging other vessels. With CAS-One, optimal access to the lesion could be planned and the procedure performed according to plan.
    Ablation was the only possible treatment as the patient refused chemotherapy.

Result:

  • The control CT shows the complete ablation of the lesion

Learn more about the stereotactic navigation system CAS-One IR.

 

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