Combined thermal-surgical ablation of locally advanced abdominopelvic malignancies

Abstract

Background: Treatment options for patients with inoperable primary or recurrent/metastatic abdominopelvic malignancies are limited, and these patients have short lifespan. The purpose of our study is to examine outcomes of combined open radiofrequency ablation (RFA) and surgical debulking of otherwise unresectable tumors.

Methods: Consecutive 50 patients were identified from an Institutional Review Board (IRB)-approved database undergoing ablation for unresectable abdominopelvic malignancies via conventional surgical methods in a single institution between 07/2003 and 09/2009. Patients were selected for debulking if they had a dominant mass that caused significant symptoms.

Results: Sixteen patients had primary tumors, and 34 presented with a recurrent/metastatic malignancy. The primary tumors were abdominopelvic sarcomas (eight patients), large desmoids (two), colorectal cancer (CRC) (two), and gastric cancer, mucinous cystic pancreatic neoplasm, gastrointestinal stromal tumor (GIST), and carcinoid (one each). The recurrent/metastatic tumors were CRCs (16 patients), abdominopelvic sarcomas (12), and GIST, prostate cancer, bladder cancer, melanoma, adrenal cancer, and pseudomyxoma peritonei recurrences (1 each). Twenty-two patients were alive and 28 died as of September 2009. Median survival for patients who died was 9.5 months and for patients who were alive was 22 months. Patients with primary tumors had 5-year survival of 18% compared with no survivors at 5 years in the recurrent/metastatic group (P = 0.002).

Conclusions: Thermosurgical ablation of otherwise unresectable primary tumors and recurrent/metastatic abdominopelvic malignancies is feasible in selected cases. Patients with ablated primary tumors have a survival advantage over patients who have ablation for recurrent/metastatic disease.