Faculty, Staff and Student Publications
Publication Date
8-30-2024
Journal
British Journal of Surgery
DOI
10.1093/bjs/znae165
PMID
39213397
PMCID
PMC11364140
PubMedCentral® Posted Date
8-30-2024
PubMedCentral® Full Text Version
Post-print
Abstract
Background: Several ablation confirmation software methods for minimum ablative margin assessment have recently been developed to improve local outcomes for patients undergoing thermal ablation of colorectal liver metastases. Previous assessments were limited to single institutions mostly at the place of development. The aim of this study was to validate the previously identified 5 mm minimum ablative margin (A0) using autosegmentation and biomechanical deformable image registration in a multi-institutional setting.
Methods: This was a multicentre, retrospective study including patients with colorectal liver metastases undergoing CT- or ultrasound-guided microwave or radiofrequency ablation during 2009-2022, reporting 3-year local disease progression (residual unablated tumour or local tumour progression) rates by minimum ablative margin across all institutions and identifying an intraprocedural contrast-enhanced CT-based minimum ablative margin associated with a 3-year local disease progression rate of less than 1%.
Results: A total of 400 ablated colorectal liver metastases (median diameter of 1.5 cm) in 243 patients (145 men; median age of 62 [interquartile range 54-70] years) were evaluated, with a median follow-up of 26 (interquartile range 17-40) months. A total of 119 (48.9%) patients with 186 (46.5%) colorectal liver metastases were from international institutions B, C, and D that were not involved in the software development. Three-year local disease progression rates for 0 mm, >0 and < 5 mm, and 5 mm or larger minimum ablative margins were 79%, 15%, and 0% respectively for institution A (where the software was developed) and 34%, 19%, and 2% respectively for institutions B, C, and D combined. Local disease progression risk decreased to less than 1% with an intraprocedurally confirmed minimum ablative margin greater than 4.6 mm.
Conclusion: A minimum ablative margin of 5 mm or larger demonstrates optimal local oncological outcomes. It is proposed that an intraprocedural minimum ablative margin of 5 mm or larger, confirmed using biomechanical deformable image registration, serves as the A0 for colorectal liver metastasis thermal ablation.
Keywords
Humans, Colorectal Neoplasms, Liver Neoplasms, Male, Retrospective Studies, Female, Middle Aged, Aged, Artificial Intelligence, Tomography, X-Ray Computed, Margins of Excision, Disease Progression, Radiofrequency Ablation
Published Open-Access
yes
Recommended Citation
Paolucci, Iwan; Albuquerque Marques Silva, Jessica; Lin, Yuan-Mao; et al., "Identification of A0 Minimum Ablative Margins for Colorectal Liver Metastases: Multicentre, Retrospective Study Using Deformable Ct Registration and Artificial Intelligence-Based Autosegmentation" (2024). Faculty, Staff and Student Publications. 4950.
https://digitalcommons.library.tmc.edu/uthgsbs_docs/4950
Correction
Included in
Bioinformatics Commons, Biomedical Informatics Commons, Genetic Phenomena Commons, Medical Genetics Commons, Oncology Commons
Comments
This article has been corrected. See Br J Surg. 2024 Oct 12;111(10):znae258. See "Curative-intent ablation margins (A0) for colorectal liver metastasis: more burning questions", znae184.