Surgical Management of Small Bowel Carcinoid with Caudate Lobe Metastasis

Background: Laparoscopic microwave ablation (MWA) is an alternative treatment option for malignant liver lesions. 1 – 4 Due to the complex anatomy, caudate lobe lesions present technical challenges in both surgical and ablative interventions. 5 – 8 While several studies report radiofrequency ablation of caudate lobe lesions, research on MWA remains limited. 7 , 9 , 10 This video demonstrates the technical feasibility of laparoscopic MWA for caudate lobe metastasis from a small bowel carcinoid. Method: This video illustrates the edited version of surgical management of the small bowel carcinoid with caudate lobe metastasis treated with resection and laparoscopic MWA, respectively. Results: The patient was a 53-year-old female with two synchronous liver metastases from small bowel carcinoid (WHO grade 2). She was admitted for the resection of the primary lesion and laparoscopic MWA of liver metastases. The tumor in segment V, measuring 31 × 25 mm, was treated with multiple overlapping ablations in total for 7 minutes. The tumor in the caudate lobe, measuring 16 × 19 mm, was treated with multiple overlapping ablations for a total of 5 minutes. The primary tumor in the small bowel was completely resected with subsequent lymphadenectomy. Operative time was 227 minutes. The patient was discharged home on postoperative day 3. There were no complications. Postoperative day 15 control computed tomography imaging showed complete ablation of the two metastatic lesions without residual tumor. Ablation zones measured 48 × 33 mm in segment V and 30 × 18 mm in the caudate lobe. Conclusions: This video demonstrated the technical details for performing laparoscopic MWA for carcinoid metastases in challenging locations. With careful patient selection and expertise in the technique, laparoscopic MWA is a viable approach for treating tumors of the caudate lobe. Ethicon and Fluoptics. He has received honoraria for consulting work. Other authors declare there are no commercial associations that might create a conflict of interest in connection with the video. Consent: The authors have received and archived patients’ consents for video recording/publication in advance of video recording of the procedure. Disclosure statement: Dr. Eren Berber has consulting agreements with Medtronic. Funding: No funding was received for the study. Runtime of video: 9 min 56 sec.