A 76-year-old patient underwent emergency surgery for a perforated cecum tumour obstructing the terminal ileum. His personal history included ischaemic heart disease with an AMI and coronary artery bypass grafting 13 and 6 years ago respectively. He underwent a right hemicolectomy and resection of 15 cm of ileum with reconstruction of the transit by means of an ileocolic anastomosis. A liver metastasis was observed in segment 8 with a size of 4 cm. A second operation was required 4 days later due to intra-abdominal abscess. The anatomopathological study was of well-differentiated adenocarcinoma with 17 lymph nodes free of tumour infiltration (T4N0M1).
Postoperative CT scan showed a 3.5 cm solid nodular lesion in segment 8 of the liver. Postoperative MQ with FOLFOX was performed and the lesion decreased in size to 2.5 cm. Six months after the intervention of the primary tumour, it was decided to perform a laparoscopic RF of the liver metastasis, given the high surgical risk of the patient.
The procedure was performed under general anaesthesia with the patient in supine decubitus. The access trocar to the abdominal cavity and for the optic was placed at epigastric level. An 11 mm trocar was used and placed below the costal ridge. The portable 7.5 Mhz laparoscopic ultrasound transducer was placed through the 11 mm trocar. No other metastatic lesions were observed on intraoperative ultrasound. Under ultrasound and laparoscopic control, the electrode was inserted in the centre of the lesion and ablated with a target temperature of 105°C, a treatment time of 6 minutes, an achieved power of 150 W and a successful ablation of the intrahepatic path. The RF electrode used was 25 cm long and had an ablation diameter of 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 RF treatment, a helical CT scan was performed, showing a hypodense lesion with absence of uptake, compatible with complete necrosis of the tumour lesion.
