Resection Versus Laparoscopic Radiofrequency Thermal Ablation Of Solitary Colorectal Liver Metastasis |
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Authors: | Eren Berber Michael Tsinberg Gurkan Tellioglu Conrad H Simpfendorfer Allan E Siperstein |
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Affiliation: | (1) Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA;(2) 9500 Euclid Avenue, /A 80, Cleveland, OH 44195, USA |
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Abstract: | Purpose There is scant data in the literature regarding radiofrequency thermal ablation (RFA) versus resection of colorectal liver
metastases. The aim of this study is to compare the clinical profile and survival of patients with solitary colorectal liver
metastasis undergoing resection versus laparoscopic RFA.
Methods Between 1996 and 2007, 158 patients underwent RFA (n = 68) and open liver resection (n = 90) of solitary liver metastasis from colorectal cancer. Patients were evaluated in a multidisciplinary fashion and allocated
to a treatment type. Data were collected prospectively for the RFA patients and retrospectively for the resection patients.
Results Although the groups were matched for age, gender, chemotherapy exposure and tumor size, RFA patients tended to have a higher
ASA score and presence of extra-hepatic disease (EHD) at the time of treatment. The main indication for referral to RFA included
technical reasons (n = 25), patient comorbidities (n = 24), extra-hepatic disease (n = 10) and patient decision (n = 9). There were no peri-operative mortalities in either group. The complication rate was 2.9% (n = 2) for RFA and 31.1% (n = 28) for resection. The overall Kaplan–Meier median actuarial survival from the date of surgery was 24 months for RFA patients
with EHD, 34 months for RFA patients without EHD and 57 months for resection patients (p < 0.0001). The 5-year actual survival was 30% for RFA patients and 40% for resection patients (p = 0.35).
Conclusions This study shows that, although patients in both groups had a solitary liver metastasis, other factors including medical comorbidities,
technically challenging tumor locations and extra-hepatic disease were different, prompting selection of therapy. With a simultaneous
ablation program, higher risk patients have been channeled to RFA, leaving a highly selected group of patients for resection
with a very favorable survival. RFA still achieved long-term survival in patients who were otherwise not candidates for resection. |
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Keywords: | Colorectal cancer Liver metastasis Radiofrequency ablation Laparoscopic |
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