Computer planned, image-guided combined resection and ablation for bilobar colorectal liver metastases

For patients with extensive bilobar colorectal liver metastases(CRLM),initial surgery may not be feasible and a multimodal approach including microwave ablation(MWA)provides the only chance for prolonged survival.Intraoperative navigation systems may improve the accuracy of ablation and surgical resection of so-called"vanishing lesions",ultimately improving patient outcome.Clinical application of intraoperative navigated liver surgery is illustrated in a patient undergoing combined resection/MWA for multiple,synchronous,bilobar CRLM.Regular follow-up with computed tomography(CT)allowed for temporal development of the ablation zones.Of the ten lesions detected in a preoperative CT scan,the largest lesion was resected and the others were ablated using an intraoperative navigation system.Twelve months post-surgery a new lesion(SegⅣa)was detected and treated by trans-arterial embo-lization.Nineteen months post-surgery new liver and lung metastases were detected and a palliative chemotherapy started.The patient passed away four years after initial diagnosis.For patients with extensive CRLM not treatable by standard surgery,navigated MWA/resection may provide excellent tumor control,improving longer-term survival.Intraoperative navigation systems provide precise,real-time information to the surgeon,aiding the decision-making process and substantially improving the accuracy of both ablation and resection.Regular follow-ups including 3D modeling allow for early discrimination between ablation zones and recurrent tumor lesions.