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. 2023 Aug 29;408(1):343.
doi: 10.1007/s00423-023-03082-1.

Survival after combined resection and ablation is not inferior to that after resection alone, in patients with four or more colorectal liver metastases

Iakovos Amygdalos  1   2 , Lea Hitpass  3   4 , Felix Schmidt  5 , Gerrit Josephs  5 , Jan Bednarsch  5   3 , Marie-Luise Berres  3   6 , Tom Lüdde  3   7 , Steven W M Olde Damink  5   8 , Tom Florian Ulmer  5   3 , Ulf P Neumann  5   3   8 , Philipp Bruners  3   4 , Sven Arke Lang  5   3
Affiliations

Survival after combined resection and ablation is not inferior to that after resection alone, in patients with four or more colorectal liver metastases

Iakovos Amygdalos et al. Langenbecks Arch Surg. .

Abstract

Purpose: Colorectal liver metastases (CRLM) are the predominant factor limiting survival in patients with colorectal cancer. Multimodal treatment strategies are frequently necessary to achieve total tumor elimination. This study examines the efficacy of liver resection combined with local ablative therapy in comparison to liver resection only, in the treatment of patients with ≥ 4 CRLM.

Methods: This retrospective cohort study was conducted at the University Hospital RWTH Aachen, Germany. Patients with ≥ 4 CRLM in preoperative imaging, who underwent curative resection between 2010-2021, were included. Recurrent resections and deaths in the early postoperative phase were excluded. Ablation modalities included radiofrequency or microwave ablation, and irreversible electroporation. Differences in overall- (OS) and recurrence-free-survival (RFS) between patients undergoing combined resection-ablation vs. resection only, were examined.

Results: Of 178 included patients, 46 (27%) underwent combined resection-ablation and 132 (73%) resection only. Apart from increased rates of adjuvant chemotherapy in the first group (44% vs. 25%, p = 0.014), there were no differences in perioperative systemic therapy. Kaplan-Meier and log-rank test analyses showed no statistically significant differences in median OS (36 months for both, p = 0.638) or RFS (9 months for combined resection-ablation vs. 8 months, p = 0.921). Cox regression analysis showed a hazard ratio of 0.891 (p = 0.642) for OS and 0.981 (p = 0.924) for RFS, for patients undergoing resection only.

Conclusion: For patients with ≥ 4 CRLM, combined resection-ablation is a viable option in terms of OS and RFS. Therefore, combined resection-ablation should be considered for complete tumor clearance, in patients with multifocal disease.

Keywords: Ablation; Colorectal liver metastases; Hepatobiliary; Surgery; Survival.

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Conflict of interest statement

The authors declare no competing interests.

The authors of this manuscript have no conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
Flowchart of inclusion and exclusion criteria, leading to the final study population. Abbreviations: CRLM, colorectal liver metastases; MSH, multi-stage hepatectomy; PT, primary tumor
Fig. 2
Fig. 2
Comparison of overall survival between RESABL and RES groups
Fig. 3
Fig. 3
Comparison of recurrence-free survival between RESABL and RES groups
See this image and copyright information in PMC

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