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Resection Versus Laparoscopic Radiofrequency Thermal Ablation of Solitary Colorectal Liver Metastasis
Eren Berber*, Michael Tsinberg, Conrad H. Simpfendorfer, Allan Siperstein
Cleveland Clinic, Cleveland, OH
Purpose: There is scant data in the literature regarding radiofrequency thermal ablation (RFA) versus resection of colorectal liver metastases. Noncomparative studies have suggested a survival benefit of RFA for unresectable colorectal liver metastases.The aim of this study is to compare the overall survival for patients with solitary colorectal liver metastasis treated with resection versus RFA from a single institution.
Methods: Between 1996 and 2007, 153 patients underwent RFA (n= 63) and open liver resection (n =90) of solitary liver metastasis from colorectal cancer. Patients were evaluated in a multidisciplinary fashion and allocated to a treatment type. Data was collected prospectively for the RFA patients and retrospectively for the resection patients.
Results: There were 97 men and 56 women with an average age of 65 years (68 for RFA and 63 for Resection, p=0.98). Mean tumor size was 3.9 cm +/- 0.4 for RFA and 3.8 cm +/- 0.4 for Resection (p=0.81). 70% of the RFA patients had an ASA score ≥ 3 vs 48% of the Resection patients (p=0.007). The main indication for RFA included technically challenging tumor location (n=23), patient comorbidities (n=20), extrahepatic disease (n=10), patient preference (n=7) and suspected bilobar disease (n=3). Overall 19 RFA patients (30%) had extrahepatic disease at the time of treatment. 81% of the RFA patients received chemotherapy preoperatively versus 68% of the Resection patients. Mean operative time was 116 +/- 7 min for RFA and 198 +/- 8 min for Resection. There were no peri-operative mortalities in either group. The complication rate was 3.1 % (n=2) for RFA and 33.7 % (n=30) for Resection. Mean length of hospitalization was 1.2 +/- 0.1 days for RFA and 6.8 +/- 0.4 days for Resection. The overall Kaplan Meier median survival from the date of surgery was 29.5 months for RFA and 64.3 months for Resection (p<0.0001). The 3- and 5-year survival rates were 35% and 19%, respectively for RFA, and 70% and 53%, respectively for Resection. The overall median survival after diagnosis of liver metastasis was 38.8 months for RFA and 72.1 months for Resection (p=0.0005).
Conclusions: This study shows that, although patients in both groups had a solitary liver metastasis, other factors including medical comorbidities, technically challenging tumor locations and extrahepatic disease were different, prompting selection of therapy. With a simultaneous ablation program, higher risk patients have been channeled to RFA, leaving a highly selected group of patients for resection with a very favorable survival.This study shows that RFA still achieved long term survival in patients who were otherwise not candidates for resection.
