From the Guidelines
Liver ablation can be considered in patients who have undergone a Whipple procedure, but it is crucial to prioritize a multidisciplinary review and careful selection of patients with small, properly located tumors, as ablation alone may be a curative treatment for tumors ≤ 3 cm. When considering liver ablation in the setting of a Whipple procedure, it is essential to take into account the potential risks and complications associated with the procedure, such as bleeding, infection, and biliary injury, which may be more challenging to manage in the post-Whipple setting due to altered anatomy 1.
Key Considerations
- The size and location of the liver lesions should be carefully evaluated, with a preference for lesions smaller than 3-4 cm, as ablation alone may be a curative treatment for tumors ≤ 3 cm 1.
- A comprehensive imaging workup, including contrast-enhanced CT or MRI, should be performed to assess the liver anatomy, which may be altered following the Whipple procedure.
- The ablation technique should be selected based on the size, number, and location of liver lesions, with radiofrequency ablation (RFA) or microwave ablation (MWA) being common options for lesions smaller than 3-4 cm.
- Prior to ablation, a thorough evaluation of the patient's performance status, liver function, and arterial anatomy of the liver should be conducted to determine the most suitable treatment approach.
Approach and Monitoring
- The procedure should be performed under general anesthesia with careful monitoring of liver function tests before and after treatment.
- Prophylactic antibiotics should be administered before the procedure to minimize the risk of infection.
- Post-ablation, patients should be closely monitored for complications, including bleeding, infection, and biliary injury, which may require prompt intervention.
- The ablation approach (percutaneous, laparoscopic, or open) should be determined based on lesion location and the patient's surgical history, with consideration that adhesions from the prior Whipple may complicate access.
From the Research
Liver Ablation in the Setting of Whipple Procedure
- The Whipple procedure, also known as pancreaticoduodenectomy, is a major surgery performed to remove a tumor or other disease in the pancreas, duodenum, or bile ducts 2, 3, 4.
- In patients with chronic liver disease (CLD), the Whipple procedure can be associated with a higher risk of complications and mortality 3.
- Liver ablation, or the destruction of liver tissue, can be a concern in the setting of Whipple procedure, particularly in patients with liver metastases or other liver diseases 5, 6.
- Studies have shown that the most common site of recurrence after Whipple procedure is the liver, highlighting the importance of monitoring liver function and detecting liver metastases early 5, 6.
- CT scans can be useful in evaluating postoperative anatomy, detecting surgical complications, and monitoring for tumor recurrence, including liver metastases, after Whipple procedure 5, 6.
- The management of liver disease in patients undergoing Whipple procedure requires careful consideration of the patient's overall health, liver function, and the potential risks and benefits of the procedure 3, 4.