Advanced Techniques in Multiple Metastases: Fiduciary Markers and Completion Ablation

Recent advances of multidisciplinary therapy including advanced techniques of interventional radiology help complete eradication of multiple colorectal liver metastases. Although prehepatectomy chemotherapy can convert initially unresectable colorectal liver metastases to resectable disease, it has a risk for disappearing of metastatic lesions. To facilitate resection of disappearing liver metastases, preoperative percutaneous placement of a fiducial marker is an option to facilitate intraoperative lesion identification after chemotherapy. For patients with insufficient future liver remnant, a new sequential treatment strategy—planned incomplete resection and postoperative completion ablation for intentionally untreated tumors—can be utilized as an alternative to intraoperative concomitant ablation. This strategy was associated with better local control and lower incidence of complications compared to intraoperative concomitant ablation in the analysis of MD Anderson Cancer Center group. These advanced techniques may improve survival in patients with multiple bilateral colorectal liver metastases.