Radiofrequency Ablation vs. Resection for Hepatic Colorectal Metastasis: Therapeutically Equivalent?
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The role of ablation for hepatic colorectal metastases (HCM) continues to evolve as ablation technology changes and systemic chemotherapy improves. Our aim was to evaluate the therapeutic efficacy of radiofrequency ablation (RFA) of HCM compared to surgical resection.
A retrospective review of our 1,105 patient prospective hepatic database from August 1995 to July 2007 identified 192 patients with only hepatic resection or only ablation for HCM.
Patients who underwent RFA were similar to resection patients based on a similar Fong score (1.8 vs. 2.1 p = 0.28), presence of extrahepatic disease (15% vs. 9% p = 0.19), mean number of hepatic lesions (2.8 vs. 2.1 p = 0.14), and prior chemotherapy (67% vs. 60% p = 0.33). Median time to recurrence was shorter with ablation than resection (12.2 vs. 31.1 months; p < 0.001). Recurrence at the ablation–resection site was more common with ablation than resection occurring 17% vs. 2% (p ≤ 0.001) of the time, respectively. Distant recurrence in the liver was also more common with ablation occurring in 33% of patients vs. 14% for resection (p = 0.002).
Surgical resection is associated with a lower chance of recurrence and a longer disease-free interval than RFA and should remain the treatment of choice in resectable HCM.
- Sjovall, A, Jarv, V, Blomqvist, L, Singnomklao, T, Cedermark, B, Glimelius, B (2004) The potential for improved outcome in patients with hepatic metastases from colon cancer: a population-based study. Eur J Surg Oncol 30: pp. 834-841 CrossRef
- Nicholl, MB, Bilchik, AJ (2008) Thermal ablation of hepatic malignancy: useful but still not optimal. Eur J Surg Oncol 34: pp. 318-323
- Couinaud, C (1957) Le Foi: Etudes Anatomogiques et Chirugicales. Masson, Paris
- Martin, RC, Edwards, MJ, McMasters, KM (2004) Morbidity of adjuvant hepatic arterial infusion pump chemotherapy in the management of colorectal cancer metastatic to the liver. Am J Surg 188: pp. 714-721 CrossRef
- Martin, RC, Scoggins, CR, McMasters, KM (2007) Microwave hepatic ablation: initial experience of safety and efficacy. J Surg Oncol 96: pp. 481-486 CrossRef
- Martin, R, Paty, P, Fong, Y, Grace, A, Cohen, A, DeMatteo, R (2003) Simultaneous liver and colorectal resections are safe for synchronous colorectal liver metastasis. J Am Coll Surg 197: pp. 233-241 CrossRef
- Curley, SA, Izzo, F, Delrio, P, Ellis, LM, Granchi, J, Vallone, P (1999) Radiofrequency ablation of unresectable primary and metastatic hepatic malignancies: results in 123 patients. Ann Surg 230: pp. 1-8 CrossRef
- Wong, SL, Edwards, MJ, Chao, C, Simpson, D, McMasters, KM (2001) Radiofrequency ablation for unresectable hepatic tumors. Am J Surg 182: pp. 552-557 CrossRef
- Oshowo, A, Gillams, A, Harrison, E, Lees, WR, Taylor, I (2003) Comparison of resection and radiofrequency ablation for treatment of solitary colorectal liver metastases. Br J Surg 90: pp. 1240-1243 CrossRef
- Aloia, TA, Vauthey, JN, Loyer, EM, Ribero, D, Pawlik, TM, Wei, SH (2006) Solitary colorectal liver metastasis: resection determines outcome. Arch Surg 141: pp. 460-466 CrossRef
- Abdalla, EK, Vauthey, JN, Ellis, LM, Ellis, V, Pollock, R, Broglio, KR (2004) Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg 239: pp. 818-825 CrossRef
- Gillams, AR, Lees, WR (2004) Radio-frequency ablation of colorectal liver metastases in 167 patients. Eur Radiol 14: pp. 2261-2267 CrossRef
- Machi, J, Oishi, AJ, Sumida, K, Sakamoto, K, Furumoto, NL, Oishi, RH (2006) Long-term outcome of radiofrequency ablation for unresectable liver metastases from colorectal cancer: evaluation of prognostic factors and effectiveness in first- and second-line management. Cancer J 12: pp. 318-326 CrossRef
- Abitabile, P, Hartl, U, Lange, J, Maurer, CA (2007) Radiofrequency ablation permits an effective treatment for colorectal liver metastasis. Eur J Surg Oncol 33: pp. 67-71
- Pawlik, TM, Scoggins, CR, Zorzi, D, Abdalla, EK, Andres, A, Eng, C (2005) Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases. Ann Surg 241: pp. 715-722 CrossRef
- Livraghi, T, Solbiati, L, Meloni, F, Ierace, T, Goldberg, SN, Gazelle, GS (2003) Percutaneous radiofrequency ablation of liver metastases in potential candidates for resection: the “test-of-time approach”. Cancer 97: pp. 3027-3035 CrossRef
- Duijnhoven, FH, Jansen, MC, Junggeburt, JM, Hillegersberg, R, Rijken, AM, Coevorden, F, van, dS (2006) Factors influencing the local failure rate of radiofrequency ablation of colorectal liver metastases. Ann Surg Oncol 13: pp. 651-658 CrossRef
- Wood, TF, Rose, DM, Chung, M, Allegra, DP, Foshag, LJ, Bilchik, AJ (2000) Radiofrequency ablation of 231 unresectable hepatic tumors: indications, limitations, and complications. Ann Surg Oncol 7: pp. 593-600
- Kokudo, N, Miki, Y, Sugai, S, Yanagisawa, A, Kato, Y, Sakamoto, Y (2002) Genetic and histological assessment of surgical margins in resected liver metastases from colorectal carcinoma: minimum surgical margins for successful resection. Arch Surg 137: pp. 833-840 CrossRef
- Radiofrequency Ablation vs. Resection for Hepatic Colorectal Metastasis: Therapeutically Equivalent?
Journal of Gastrointestinal Surgery
Volume 13, Issue 3 , pp 486-491
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