Resection or radiofrequency ablation of colorectal liver metastasis

Damir Jašarović; Dragoš Stojanović; Nebojša Mitrović; Dejan Stevanović

doi:10.2298/2185

Damir Jašarović Clinical Hospital Center Zemun, Belgrade, Serbia
Dragoš Stojanović Clinical Hospital Center Zemun, Belgrade, Serbia
Nebojša Mitrović Clinical Hospital Center Zemun, Belgrade, Serbia
Dejan Stevanović Clinical Hospital Center Zemun, Belgrade, Serbia

DOI: https://doi.org/10.2298/2185

Keywords: colorectal neoplasms, digestive system surgical procedures, liver neoplasms, neoplasm metastasis, catheter ablation, treatment outcome,

Abstract

Background/Aim. Liver resection is the treatment of choice for solitary colorectal liver metastases in suitable candidates. Recently, radiofrequency ablation (RFA) has become a very popular procedure in the treatment of liver metastases. The aim of this study was to compare outcomes in patients with solitary colorectal liver metastasis who had been subjected to resection or ablation. Methods. In this retrospective study we analyzed and compared patients with solitary colorectal liver metastases treated by resection or ablation in the University Hospital Centre “Dr Dragiša Mišović” in Belgrade from January 2002 until December 2009. Results. In this study 94 (67.1%) patients underwent resection whereas 46 (32.9%) patients underwent RFA. Most of the resected patients (59.6%) required major hepatectomy. The median follow-up time was 28.4 months. Tumor ablation was a significant predictor of the overall survival (p = 0.002; OR 3.75; 95% CI 1.696–8.284). Our study demonstrated longer disease free-survival in the group of resected patients compared to the RFA group (37.6 vs 22.3 months, p = 0.073). The median overall survival was 56.3 months for patients who underwent resection vs 25.1 months for those in the RFA group (p = 0.005). Conclusion. This study shows that the patients with solitary hepatic colorectal cancer metastases should be considered for hepatic resection whenever it is feasible, because this procedure provides superior long-term survival as compared to radiofrequency ablation.

References

Siperstein AE, Berber E, Ballem N, Parikh RT. Survival after ra-diofrequency ablation of colorectal liver metastases: 10-year experience. Ann Surg 2007; 246(4): 559−65; discussion 565−7.

Biasco G, Derenzini E, Grazi G, Ercolani G, Ravaioli M, Pantaleo MA, et al. Treatment of hepatic metastases from colorectal cancer: many doubts, some certainties. Cancer Treat Rev 2006; 32(3): 214−28.

Abdalla EK, Vauthey JN, Ellis LM, Ellis V, Pollock R, Broglio KR, et al. Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg 2004; 239(6): 818−25; discussion 825−7.

Oshowo A, Gillams A, Harrison E, Lees WR, Taylor I. Comparison of resection and radiofrequency ablation for treatment of solitary colorectal liver metastases. Br J Surg 2003; 90(10): 1240−3.

Aloia TA, Vauthey JN, Loyer EM, Ribero D, Pawlik TM, Wei SH, et al. Solitary colorectal liver metastasis: resection determines outcome. Arch Surg 2006; 141(5): 460−6; discussion 466−7.

Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH. Clinical score for predicting recurrence after hepatic resection for me-tastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 1999; 230(3): 309−18; discussion 318−21.

Cummings LC, Payes JD, Cooper GS. Survival after hepatic resec-tion in metastatic colorectal cancer: a population-based study. Cancer 2007; 109(4): 718−26.

Minagawa M, Makuuchi M, Torzilli G, Takayama T, Kawasaki S, Kosuge T, et al. Extension of the frontiers of surgical indica-tions in the treatment of liver metastases from colorectal can-cer: long-term results. Ann Surg 2000; 231(4): 487−99.

Kokudo N, Miki Y, Sugai S, Yanagisawa A, Kato Y, Sakamoto Y, et al. Genetic and histological assessment of surgical margins in resected liver metastases from colorectal carcinoma: mini-mum surgical margins for successful resection. Arch Surg 2002; 137(7): 833−40.

Ohlsson B, Stenram U, Tranberg KG. Resection of colorectal liver metastases: 25-year experience. World J Surg 1998; 22(3): 268−76; discussion 276−7.

Siperstein A, Garland A, Engle K, Rogers S, Berber E, Foroutani A, et al. Local recurrence after laparoscopic radiofrequency ther-mal ablation of hepatic tumors. Ann Surg Oncol 2000; 7(2): 106−13.

McKay A, Fradette K, Lipschitz J. Long-term outcomes following hepatic resection and radiofrequency ablation of colorectal liver metastases. HPB Surg 2009; 2009: 346863..

Hur H, Ko YT, Min BS, Kim KS, Choi JS, Sohn SK, et al. Com-parative study of resection and radiofrequency ablation in the treatment of solitary colorectal liver metastases. Am J Surg 2009; 197(6): 728−36.

McKay A, Dixon E, Taylor M. Current role of radiofrequency ablation for the treatment of colorectal liver metastases. Br J Surg 2006; 93(10): 1192−201.

Wood TF, Rose DM, Chung M, Allegra DP, Foshag LJ, Bilchik AJ. Radiofrequency ablation of 231 unresectable hepatic tumors: indications, limitations, and complications. Ann Surg Oncol 2000; 7(8): 593−600.

Feliberti EC, Wagman LD. Radiofrequency ablation of liver me-tastases from colorectal carcinoma. Cancer Control 2006; 13(1): 48−51.

Penna C, Nordlinger B. Colorectal metastasis (liver and lung). Surg Clin North Am 2002; 82(5): 1075−90, x−xi.

Mulier S, Ni Y, Jamart J, Michel L, Marchal G, Ruers T. Radiofre-quency ablation versus resection for resectable colorectal liver metastases: time for a randomized trial? Ann Surg Oncol 2008; 15(1): 144−57.