Hepatectomy Is Superior to Thermal Ablation for Patients with a Solitary Colorectal Liver Metastasis
Suzanne C. Schiffman*, Matthew Bower, Russell E. Brown, Robert C. C. Martin, Kelly M. Mcmasters, Charles R. Scoggins
Surgery, University of Louisville, Louisville, KY
Purpose: Hepatic resection is the mainstay of treatment for solitary colorectal liver metastases (mCRC); however, some patients are not ideal candidates for resection. The aim of this study was to compare outcomes for patients whose solitary mCRC was either resected or ablated. Methods: A retrospective review of a hepatobiliary database identified consecutive patients with solitary colorectal metastasis to the liver who underwent surgical therapy from 3/1995 to 5/2009. Patients who were treated with hepatectomy were compared to patients who underwent thermal ablation using logistic regression, Chi square, and the t-test where appropriate. Survival was plotted using the method of Kaplan-Meier and compared using the log-rank test.Results: 140 patients with a solitary hepatic mCRC were identified. The median follow-up time was 25.9 months. Ninety-four patients (67.1 %) underwent resection whereas 46 patients (32.8 %) underwent ablation. Of the resected patients, most (60%) required a major hepatectomy. There were no significant differences in gender (p=0.632), age (p=0.992), use of pre-hepatectomy chemotherapy (p=0.702), primary tumor nodal status (p=0.368) or synchronous vs. metachronous metastases (p=0.627) between patients who underwent resection versus ablation. Resected patients had larger metastatic tumor sizes than ablated patients (5.6 cm vs. 3.85 cm, respectively; p=0.004). Multivariate analysis revealed that ablation was the only predictor of recurrence (p=0.008, OR 2.857, 95% CI 1.311-6.225). Age, T stage, N stage, and use of pre-hepatectomy chemotherapy did not impact recurrence. Similarly, shorter overall survival was predicted by tumor ablation (p=0.002, OR 3.75, 95% CI 1.696-8.284). Overall, the median disease-free survival was 55.2 months for patients undergoing resection vs. 42.6 months for ablated patients (p= 0.073). Median overall survival was 112.7 months for patients undergoing resection vs. 50.2 months for patients undergoing ablation (p= 0.005). Conclusion: Patients with solitary hepatic colorectal cancer metastases should be considered for hepatic resection as this provides superior survival when compared to thermal ablation.
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