Traveling for pancreatic cancer care is worth the trip

Abstract

selection, perioperative procedures and outcomes reporting. The aim of this study is to present our 10-year, singlecenter experience of minimally-invasive and open MWA for NLM. Methods: A retrospective review of patients who underwent surgical MWA from 2008-2018 at our tertiary institution was performed and only patients treated with surgical MWA for NLM were included. Patient demographics (age, sex, race) and outcomes (treatment modality, tumor characteristics, presence of symptoms/symptom improvement, regional and metastatic recurrence) were entered into a custom REDCapÒ database. Patients were broadly divided as to whether MWA was performed for curative intent [CI] (no evidence of disease after ablation of all detectable liver tumors and no extrahepatic disease at conclusion of planned procedures) or cytoreduction [CR] (intentionally untreated intrahepatic or known extrahepatic disease). Results: Of the 50 patients who underwent surgical MWA for NLM, 78% (39/50) were able to be treated with a minimally-invasive approach. Overall, 68% (34/50) underwent ablation for curative intent, and of these patients 38% (13/34) underwent concurrent hepatectomy. Of the 40% (20/50) of patients experiencing carcinoid symptoms refractory to medical therapy preoperatively, treatment improved symptoms in 92.3% (12/13) of patients treated with curative intent and 100% (7/7) for patients treated for cytoreduction. Postoperative imaging within 12 months of surgical MWA revealed incomplete ablation/local recurrence in 20.6% (7/34) of CI patients. Median follow-up for patients treated with curative intent was 27.3 months (10.4-39.1 IQR) with overall recurrence in 50% (17/34). Median recurrence for curative intent was similar between minimally-invasive (n = 27) and open (n = 7) MWA operations (14.9 versus 12.7 months). Conclusion:Microwave ablation with and without concurrent liver resection for neuroendocrine liver metastases is an effective alternative for select patients. Microwave ablation provides excellent symptom control for patients treated with curative or cytoreductive intent. A minimallyinvasive approach is oncologically comparable to open microwave ablation.