Annals of Surgical Oncology

, Volume 15, Issue 1, pp 144–157

Radiofrequency Ablation Versus Resection for Resectable Colorectal Liver Metastases: Time for a Randomized Trial?

  • Stefaan Mulier
  • Yicheng Ni
  • Jacques Jamart
  • Luc Michel
  • Guy Marchal
  • Theo Ruers
Hepatic and Pancreatic Tumors

DOI: 10.1245/s10434-007-9478-5

Cite this article as:
Mulier, S., Ni, Y., Jamart, J. et al. Ann Surg Oncol (2008) 15: 144. doi:10.1245/s10434-007-9478-5

Abstract

Background

Surgical resection is the gold standard in the treatment of resectable colorectal liver metastases (CRLM). In several centers, resection is being replaced by radiofrequency ablation (RFA), even though there is no evidence yet from randomized trials to support this. The aim of this study was to critically review the oncological evidence for and against the use of RFA for resectable CRLM.

Methods

An exhaustive review of RFA of colorectal metastases was carried out.

Results

Five-year survival data after RFA for resectable CRLM are not available. Percutaneous RFA is associated with worse local control, worse staging, and a small risk of electrode track seeding when compared with resection (level V evidence). For tumors ≤3 cm, local control after surgical RFA is equivalent to resection, especially if applied by experienced physicians to nonperivascular tumors (level V evidence). There is indirect evidence for profoundly different biological effects of RFA and resection.

Conclusions

A subgroup of patients has been identified for whom local control after RFA might be equivalent to resection. Whether this is true, and whether this translates into equivalent survival, remains to be proven. The time has come for a randomized trial.

Keywords

Colorectal liver metastasesRadiofrequencyResectionReviewRandomized trial

Copyright information

© Society of Surgical Oncology 2007

Authors and Affiliations

  • Stefaan Mulier
    • 1
    • 2
  • Yicheng Ni
    • 2
  • Jacques Jamart
    • 3
  • Luc Michel
    • 4
  • Guy Marchal
    • 2
  • Theo Ruers
    • 5
  1. 1.Department of SurgeryLeopold Park ClinicBrusselsBelgium
  2. 2.Department of RadiologyUniversity Hospital Gasthuisberg, Catholic University of LeuvenLeuvenBelgium
  3. 3.Department of BiostatisticsUniversity Hospital of Mont-Godinne, Catholic University of LouvainYvoirBelgium
  4. 4.Department of SurgeryUniversity Hospital of Mont-Godinne, Catholic University of LouvainYvoirBelgium
  5. 5.Department of SurgeryAntoni van Leeuwenhoek Hospital, The Netherlands Cancer InstituteAmsterdamThe Netherlands