Background
Although radiofrequency ablation (RFA) has been incorporated to the treatment algorithm
of patients with unresectable colorectal liver metastasis (CLM), its utility in patients
with resectable disease has not been well studied. The aims of this study were to
define the clinical profile of patients with a solitary CLM who underwent laparoscopic
RFA and to analyze their oncologic outcomes.
Methods
Between 2000 and 2011, 44 patients underwent laparoscopic RFA and 60 patients resection
of solitary CLM ≤3 cm. Data were analyzed from a prospectively maintained institutional
review board-approved database using Student's t test, Chi-square, and Kaplan–Meier tests.
Results
The indications for RFA were patient decision in 61% (n = 27), comorbidities in 34% (n = 15), and intraoperative findings in 5% (n = 2). In comparison with the resection group, RFA patients had a greater American
Society of Anesthesiologists score (3.0 ± 0.1 vs 2.6 ± 0.1, respectively; P = .002), more frequent incidence of cardiopulmonary comorbidities (60% vs 38%, respectively;
P = .045), and tumors located deeper in the liver parenchyma (39% vs 12%) that would
have required a formal lobectomy. The 2 groups were otherwise similar for age, gender,
carcinoembrradyogenic antigen, synchronous versus metachronous presentation of CLM,
tumor size, and tumor and nodal status of primary colorectal cancer. The local recurrence
rate was 18% after RFA and 4% after resection (P = .012). The overall Kaplan–Meier, cancer-specific, 5-year survival was 47% for RFA
and 57% for resection (P = .464). Median disease-free survival was 25 months after RFA and 22 months after
resection (P = .973).
Conclusion
Our results suggest that laparoscopic RFA might spare a number of patients at greater
risk with a small solitary CLM the risk of morbidity from a formal liver resection.
Furthermore, laparoscopic RFA might also be acceptable as the first line of therapy
for patients with tumors that otherwise would have required a formal lobectomy or
open resection. Nevertheless, the local recurrence rate of RFA should be kept in mind
and the patients followed closely to treat failures promptly.
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Article info
Publication history
Published online: July 15, 2013
Accepted:
March 25,
2013
Identification
Copyright
© 2013 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
