J Korean Surg Soc.  2011 Jul;81(1):25-34. 10.4174/jkss.2011.81.1.25.

Comparative analysis of radiofrequency ablation and surgical resection for colorectal liver metastases

• Kim KH
• Yoon YS
• Yu CS
• Kim TW
• Kim HJ
• Kim PN
• Ha HK
• Kim JC

• KMID: 1853528
• DOI: http://doi.org/10.4174/jkss.2011.81.1.25

Abstract

PURPOSE
To evaluate the comparative therapeutic efficacy of radiofrequency ablation (RFA) and hepatic resection for the treatment of colorectal liver metastasis (CRLM).
METHODS
Between 1996 and 2008, 177 patients underwent RFA, 278 underwent hepatic resection and 27 underwent combination therapy for CRLM. Comparative analysis of clinical outcomes was performed including number of liver metastases, tumor size, and time of CRLM.
RESULTS
Based on multivariate analysis, overall survival (OS) correlated with the number of liver metastases and the use of combined chemotherapy (P < 0.001, respectively). Disease-free survival (DFS) also correlated with the number of liver metastases (P < 0.001). In the 226 patients with solitary CRLM < 3 cm, OS and DFS rates did not differ between the RFA group and the resection group (P = 0.962 and P = 0.980). In the 70 patients with solitary CRLM > or = 3 cm, DFS was significantly lower in the RFA group as compared with the resection group (P = 0.015).
CONCLUSION
The results indicate that RFA may be a safe alternative treatment for solitary CRLM less than 3 cm, with outcomes equivalent to those achieved with hepatic resection. A randomized controlled study comparing RFA and resection for patients with single small metastasis would help to determine the most efficient treatment modalities for CRLM.

Keyword

Radiofrequency ablation; Hepatectomy; Colorectal neoplasms; Liver metastasis

MeSH Terms

Colorectal Neoplasms
Disease-Free Survival
Hepatectomy
Humans
Liver
Multivariate Analysis
Neoplasm Metastasis

Figure

• 

  Fig. 1 Examples of radiologic images indicating that radiofrequency ablation (RFA) was recommended in the current study. (A) Anatomic sites difficult for resection (left image, pre-RFA; right image, post-RFA). (B) Multiple lesions treated with combination therapy (left images, pre-treatment; right images, post-treatment).

• 

  Fig. 2 Survival of patients with solitary colorectal liver metastasis less than 3 cm treated by radiofrequency ablation (RFA) and resection. (A) Overall survival (P = 0.962). (B) Disease-free survival (P = 0.980).

• 

  Fig. 3 Survival of patients with solitary colorectal liver metastasis equal to or greater than 3 cm treated by radiofrequency ablation (RFA) and resection. (A) Overall survival (P = 0.152). (B) Disease-free survival (P = 0.015).

• 

  Fig. 4 Survival of patients with multiple colorectal liver metastasis treated by radiofrequency ablation (RFA), resection and combination therapy. (A) Overall survival (P = 0.330). (B) Disease-free survival (P = 0.037).

Reference

1. Scheele J, Stang R, Altendorf-Hofmann A, Paul M. Resection of colorectal liver metastases. World J Surg. 1995. 19:59–71.

2. Wilson SM, Adson MA. Surgical treatment of hepatic metastases from colorectal cancers. Arch Surg. 1976. 111:330–334.

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. 141:460–466.

4. Mulier S, Ni Y, Jamart J, Michel L, Marchal G, Ruers T. Radiofrequency ablation versus resection for resectable colorectal liver metastases: time for a randomized trial? Ann Surg Oncol. 2008. 15:144–157.

5. Feliberti EC, Wagman LD. Radiofrequency ablation of liver metastases from colorectal carcinoma. Cancer Control. 2006. 13:48–51.

6. Livraghi T, Solbiati L, Meloni MF, Gazelle GS, Halpern EF, Goldberg SN. Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study. Radiology. 2003. 226:441–451.

7. Curley SA, Marra P, Beaty K, Ellis LM, Vauthey JN, Abdalla EK, et al. Early and late complications after radiofrequency ablation of malignant liver tumors in 608 patients. Ann Surg. 2004. 239:450–458.

8. Curley SA, Izzo F. Radiofrequency ablation of primary and metastatic hepatic malignancies. Int J Clin Oncol. 2002. 7:72–81.

9. Mulier S, Ni Y, Jamart J, Ruers T, Marchal G, Michel L. Local recurrence after hepatic radiofrequency coagulation: multivariate meta-analysis and review of contributing factors. Ann Surg. 2005. 242:158–171.

10. Reuter NP, Woodall CE, Scoggins CR, McMasters KM, Martin RC. Radiofrequency ablation vs. resection for hepatic colorectal metastasis: therapeutically equivalent? J Gastrointest Surg. 2009. 13:486–491.

11. Park IJ, Kim HC, Yu CS, Kim PN, Won HJ, Kim JC. Radiofrequency ablation for metachronous liver metastasis from colorectal cancer after curative surgery. Ann Surg Oncol. 2008. 15:227–232.

12. Higgins H, Berger DL. RFA for liver tumors: does it really work? Oncologist. 2006. 11:801–808.

13. Mayo SC, Pawlik TM. Current management of colorectal hepatic metastasis. Expert Rev Gastroenterol Hepatol. 2009. 3:131–144.

14. Smith MD, McCall JL. Systematic review of tumour number and outcome after radical treatment of colorectal liver metastases. Br J Surg. 2009. 96:1101–1113.

15. Buscarini E, Savoia A, Brambilla G, Menozzi F, Reduzzi L, Strobel D, et al. Radiofrequency thermal ablation of liver tumors. Eur Radiol. 2005. 15:884–894.

16. 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. 90:1240–1243.

17. Gillams AR, Lees WR. Radiofrequency ablation of colorectal liver metastases. Abdom Imaging. 2005. 30:419–426.

18. Pawlik TM, Izzo F, Cohen DS, Morris JS, Curley SA. Combined resection and radiofrequency ablation for advanced hepatic malignancies: results in 172 patients. Ann Surg Oncol. 2003. 10:1059–1069.

19. Abitabile P, Hartl U, Lange J, Maurer CA. Radiofrequency ablation permits an effective treatment for colorectal liver metastasis. Eur J Surg Oncol. 2007. 33:67–71.

20. Hur H, Ko YT, Min BS, Kim KS, Choi JS, Sohn SK, et al. Comparative study of resection and radiofrequency ablation in the treatment of solitary colorectal liver metastases. Am J Surg. 2009. 197:728–736.

21. Otto G, Düber C, Hoppe-Lotichius M, König J, Heise M, Pitton MB. Radiofrequency ablation as first-line treatment in patients with early colorectal liver metastases amenable to surgery. Ann Surg. 2010. 251:796–803.

22. Sutherland LM, Williams JA, Padbury RT, Gotley DC, Stokes B, Maddern GJ. Radiofrequency ablation of liver tumors: a systematic review. Arch Surg. 2006. 141:181–190.

23. McKay A, Dixon E, Taylor M. Current role of radiofrequency ablation for the treatment of colorectal liver metastases. Br J Surg. 2006. 93:1192–1201.

24. 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. 239:818–825.

25. Chen MS, Li JQ, Zheng Y, Guo RP, Liang HH, Zhang YQ, et al. A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma. Ann Surg. 2006. 243:321–328.

26. Shibata T, Niinobu T, Ogata N, Takami M. Microwave coagulation therapy for multiple hepatic metastases from colorectal carcinoma. Cancer. 2000. 89:276–284.

27. Evrard S, Becouarn Y, Fonck M, Brunet R, Mathoulin-Pelissier S, Picot V. Surgical treatment of liver metastases by radiofrequency ablation, resection, or in combination. Eur J Surg Oncol. 2004. 30:399–406.

28. Adam R, Delvart V, Pascal G, Valeanu A, Castaing D, Azoulay D, et al. Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg. 2004. 240:644–657.

29. Tanabe KK, Kulu Y. Radiofrequency ablation for colon and rectal carcinoma liver metastases: what's missing? Gastrointest Cancer Res. 2007. 1:4 Suppl 2. S42–S46.