2005 Abstracts: Comparison of Ablative Cytoreduction with or without Resection Versus Resection Alone for Hepatic Colorectal Metastases
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Comparison of Ablative Cytoreduction with or without Resection Versus Resection Alone for Hepatic Colorectal Metastases
Perry Shen, Wake Forest School of Medicine, Winston-Salem, NC; Jamie Forrest, Wake Forest Physician Assistant Program, Winston-Salem, NC; Jose Rodriguez, Wake Forest School of Medicine, Winston-Salem, NC; Aaron Carter, Ron Zagoria, Russell Howerton, Edward Levine, Thomas McCoy, Wake Forest University School of Medicine, Winston-Salem, NC
Introduction: Resection provides the best chance for long-term survival in patients with hepatic colorectal metastases. Radiofrequency ablation (RFA) and cryosurgical ablation (CSA) have expanded the indications for surgical therapy of hepatic colorectal metastases. Clinical outcomes of patients undergoing ablative therapy with or without resection are not well documented.
Methods: Retrospective review of consecutive patients undergoing surgery for hepatic colorectal metastases from August 1994 through November 2004. Patients were treated with hepatic resection for resectable disease, and ablation or combined resection/ablation for unresectable disease. All patients undergoing ablation as part of their procedure were considered as one group for analysis. Results: One hundred forty-five patients were analyzed with the following classification: 88 (61%) resection alone and 57 (39%) ablation alone or combined resection/ablation. The median follow-up was 11.3 months. The only significant differences between the resection and ablation group were the increase in bilobar disease (p<0.0001), and total number of hepatic lesions (p=0.0002) for the ablation group. Three year overall survival (OS), disease-free survival (DFS), and hepatic disease-free survival (HDFS) for the resection and ablation groups were 67% versus 51%, 30% versus 17%, and 44% versus 26%, respectively. For the entire study cohort, the 3-year OS, DFS, and HDFS were 61%, 19%, and 30% respectively. The median OS, DFS, and HDFS were 42, 13, and 17 months, respectively. The 30 day perioperative mortality of the resection and ablation groups was 4.6% and 2.0%, respectively. The use of postoperative systemic chemotherapy was associated with improved OS (p=0.0194). Conclusion: The use of RFA or CSA for patients with unresectable hepatic colorectal metastases as primary therapy or in combination with resection produced clinical outcomes comparable to resection alone. Postoperative chemotherapy may further enhance outcomes of ablation in these patients. Further follow-up is needed to determine long-term efficacy.
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