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Comparative Study
. 2004 Jun;239(6):818-25; discussion 825-7.
doi: 10.1097/01.sla.0000128305.90650.71.

Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases

Eddie K Abdalla  1 , Jean-Nicolas Vauthey, Lee M Ellis, Vickie Ellis, Raphael Pollock, Kristine R Broglio, Kenneth Hess, Steven A Curley
Affiliations
Comparative Study

Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases

Eddie K Abdalla et al. Ann Surg. 2004 Jun.

Abstract

Objective: To examine recurrence and survival rates for patients treated with hepatic resection only, radiofrequency ablation (RFA) plus resection or RFA only for colorectal liver metastases.

Summary background data: Thermal destruction techniques, particularly RFA, have been rapidly accepted into surgical practice in the last 5 years. Long-term survival data following treatment of colorectal liver metastasis using RFA with or without hepatic resection are lacking.

Methods: Data from 358 consecutive patients with colorectal liver metastases treated for cure with hepatic resection +/- RFA and 70 patients found at laparotomy to have liver-only disease but not to be candidates for potentially curative treatment were compared (1992-2002).

Results: Of 418 patients treated, 190 (45%) underwent resection only, 101 RFA + resection (24%), 57 RFA only (14%), and 70 laparotomy with biopsy only or arterial infusion pump placement ("chemotherapy only," 17%). RFA was used in operative candidates who could not undergo complete resection of disease. Overall recurrence was most common after RFA (84% vs. 64% RFA + resection vs. 52% resection only, P < 0.001). Liver-only recurrence after RFA was fourfold the rate after resection (44% vs. 11% of patients, P < 0.001), and true local recurrence was most common after RFA (9% of patients vs. 5% RFA + resection vs. 2% resection only, P = 0.02). Overall survival rate was highest after resection (58% at 5 years); 4-year survival after resection, RFA + resection and RFA only were 65%, 36%, and 22%, respectively (P < 0.0001). Survival for "unresectable" patients treated with RFA + resection or RFA only was greater than chemotherapy only (P = 0.0017).

Conclusions: Hepatic resection is the treatment of choice for colorectal liver metastases. RFA alone or in combination with resection for unresectable patients does not provide survival comparable to resection, and provides survival only slightly superior to nonsurgical treatment.

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Figures

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FIGURE 1. Distribution of patient groups studied. CRC, colorectal cancer.
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FIGURE 2. Recurrence following resection only, RFA + resection and RFA only. Recurrence at any local or distant site (A, *P < 0.001 compared with resection only), recurrence at any site within the liver, without evidence of distant metastasis (B, *P < 0.001 compared with resection only), and true local recurrence (C, *P = 0.02 compared with resection only) (patients in C are a subgroup of those in B).
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FIGURE 3. Overall survival stratified by treatment. Overall survival for the entire group treated with curative intent (A), stratified by surgical treatment of cure (B), and stratified by treatment of “unresectable” patients (C).
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FIGURE 4. Overall survival stratified by tumor number. Overall survival for all surgically treated patients stratified by number of tumors (A), for the subset of patients with 2 or 3 tumors stratified by surgical treatment (B), and for the subset of patients with solitary tumors stratified by surgical treatment (C).
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FIGURE 5. Recurrence-free survival. Recurrence-free survival for the entire group treated for cure (A) and stratified by treatment type (B).
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References

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