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Thermal ablation versus hepatic resection for colorectal cancer with synchronous liver metastases: a propensity score matching study

  • Gastrointestinal
  • Published:
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Abstract

Objectives

Several studies have compared the efficacy of hepatic resection (HR) and thermal ablation (TA) for unresectable tumors; however, results remain inconsistent. Most cohorts in previous studies were heterogeneous groups of synchronous colorectal liver metastases (CRLM) and extrahepatic metastases. This retrospective study aimed to compare the therapeutic efficacy between TA and HR in synchronous CRLM without extrahepatic metastases.

Methods

Cases with initially synchronous CRLM without extrahepatic metastases between January 2007 and December 2018 were enrolled. Of the 448 cases, 346 received HR and 102 TA. Propensity score matching with a 1:1 ratio was used to improve the comparability between the HR and TA groups. Technical success, complications, disease-free survival (DFS), and overall survival (OS) were compared before and after matching.

Results

All patients achieved technical success. Major complication rates in the HR and TA groups were, respectively, 36.7% and 8.8% (p < 0.001). Before matching, the 5-year OS and DFS (p = 0.004 and p = 0.020, respectively) were significantly higher in the HR group than in the TA group. After matching, no significant difference in the 5-year OS and DFS was found between the groups (p = 0.770 and p = 0.939, respectively). Local tumor progression rate was significantly higher in the TA group both before (p = 0.027) and after (p = 0.029) matching.

Conclusions

For patients with CRC with synchronous CRLM, TA and HR provide comparable OS and DFS. TA is preferable if complete ablation is predicted.

Key Points

• Thermal ablation and hepatic resection provide comparable overall survival and disease-free survival.

• Thermal ablation is a safe and effective treatment for patients with colorectal cancer with synchronous liver metastases and has a lower major complication rate and higher repeatability than hepatic resection.

• Thermal ablation is preferable if complete ablation is predicted.

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Abbreviations

CEA:

Carcinoembryonic antigen

CRC:

Colorectal cancer

CRLM:

Colorectal liver metastases

DFS:

Disease-free survival

IDR:

Intrahepatic distant recurrence

LTP:

Local tumor progression

MDT:

Multidisciplinary team

MWA:

Microwave ablation

OS:

Overall survival

RFA:

Radiofrequency ablation

TA:

Thermal ablation

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Acknowledgements

The author would thank the staff of the Department of Colorectal Surgery, Fudan University Shanghai Cancer Center. This study was supported by the Science and Technology Commission of Shanghai Municipality (grant numbers: 20DZ1100101 and 19511121202).

Funding

This study was supported by the Science and Technology Commission of Shanghai Municipality (grant numbers: 20DZ1100101 and 19511121202). The funding source played no role in research design and collection, analysis, report writing, and the decision to submit articles for publication.

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Author notes

  1. Yun Xu and Yuqin Zhang contributed equally to this work.

Authors and Affiliations

  1. Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Dong’an road, 270, Shanghai, 200032, People’s Republic of China

    Yun Xu, Yuqin Zhang, Cong Li, Tian’an Guo & Ye Xu

  2. Mechanical & Aerospace Engineering, University of California, 7400 Boelter Hall Los Angeles, Los Angeles, CA, 90095, USA

    Charlie Zhilin Zheng

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  1. Yun Xu
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Corresponding author

Correspondence to Ye Xu.

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Guarantor

The scientific guarantor of this publication is Ye Xu.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been reported in previous studies (Reuter et al J Gastrointest Surg 2009 Mar 10.1007/s11605-008-0727-0; Dupré et al Eur J Surg Oncol 2017 Oct 10.1016/j.ejso.2017.08.008; Tinguely et al Eur J Surg Oncol 2020 Mar 10.1016/j.ejso.2019.12.002. While these studies found that patients who received hepatic resection (HR) had better survival and lower local recurrence rates, selection bias was possible because thermal ablation (TA) was mostly used for unresectable CRLM. In addition, cohorts in previous studies were heterogeneous groups of synchronous CRLM, metachronous CRLM, and extrahepatic metastases. Hence, this study aimed to compare the therapeutic efficacy between TA and HR in treating synchronous CRLM without extrahepatic metastases using propensity score matching and to determine the feasibility, local efficacy, and long-term outcomes of TA for patients with synchronous CRLM only.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

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Xu, Y., Zhang, Y., Zheng, C.Z. et al. Thermal ablation versus hepatic resection for colorectal cancer with synchronous liver metastases: a propensity score matching study. Eur Radiol 32, 6678–6690 (2022). https://doi.org/10.1007/s00330-022-09080-z

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