Two probe microwave ablation of a large liver metastasis
Tissue spearing microwave ablation after extended right hemihepatectomy. Lesion, progressive in size to 43 x 36 mm at the time of the intervention, was fully covered by the ablation volume. In addition a 5-mm satellite tumour dorsocranial to the main lesion showed in the planning scan. They were treated with a double needle configuration and repositioning after the initial ablation. In the postinterventional control scan, the lesion was completely covered without evidence of periinterventional complications.
![01_Plan2_2022-01-17Freiburg_case](https://www.cascination.com/hs-fs/hubfs/01_Plan2_2022-01-17Freiburg_case.png?width=1240&name=01_Plan2_2022-01-17Freiburg_case.png)
Planning scan showing the two trajectories with the expected large ablation zone of the dual needle configuration
![02_Needle2_3dFreiburg_case](https://www.cascination.com/hs-fs/hubfs/02_Needle2_3dFreiburg_case.png?width=1240&name=02_Needle2_3dFreiburg_case.png)
![03_Assess_2022-01-21 142753_freiburg_case](https://www.cascination.com/hs-fs/hubfs/03_Assess_2022-01-21%20142753_freiburg_case.png?width=1240&name=03_Assess_2022-01-21%20142753_freiburg_case.png)
![04_Second_Plan_2022-01-17 142524_freiburg_case](https://www.cascination.com/hs-fs/hubfs/04_Second_Plan_2022-01-17%20142524_freiburg_case.png?width=1240&name=04_Second_Plan_2022-01-17%20142524_freiburg_case.png)
Name: Prof. Dr. Wibke Uller and Dr. Michael Doppler
Institution: Universitätsklinikum Freiburg, Freiburg (Germany)
Patient age and sex: 64 years, male
Initial condition:
- 2016: Initial diagnosis of a neuroendocrine tumour of the pancreatic head. Condition after laparoscopic enucleation
- 2017: During follow-up, hepatic space-occupying lesions were noted, as well as a stenosing space-occupying lesion of the right colonic felxur. Histological confirmation of the space-occupying mass of the colon (adenocarcinoma of the colon)
- 2017: right hemicolectomy, and atypical liver resection from liver segments II/III, III, and extended right hemihepatectomy (multi-stage procedure). Detection of hepatic metastases of adenocarcinoma of the colon in the intraoperative fast track samples
- Since 2017: inconspicuous follow-up
- November 2021: Newly appeared mass in the central residual liver (39 x 32 mm)
- December 2021: Tumour board decision for microwave ablation
Treatment:
- January 2022: Bioptic confirmation and MWA of the focus (pathology: metastasis of adenocarcinoma of the colon). In CT accompanying the examination, the lesion was progressive in size to currently 43 x 36 mm
- In addition, a new 5-mm satellite dorsocranial to the main lesion was seen compared with the previous findings
Conclusion:
- In the postinterventional control, the lesion was completely covered without evidence of periinterventional complications
- Follow-up by MRI or CT is still pending
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