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2007 Program and Abstracts | 2007 Posters
Current Role of Radiofrequency Ablation for the Treatment of Colorectal Liver Metastases
Gennady Vorobiev1, Vladislav Kosyrev2, Vladimir Kashnikov1, Larisa Orlova1, Evgeny Rybakov*1, Dmitry Pikunov1
1State Research Center of coloproctology, Moscow, Russian Federation; 2Blokhin Cancer Research Center RAMS, Moscow, Russian Federation

Background: Up to 50% individuals affected by colorectal cancer (CRC) are presented with synchronous or metachronous liver metastases (LM). The liver resection is available in small number of CRC cases, while majority of patients are candidates for chemotherapy and local ablation procedures. Radiofrequency ablation (RFA) for the treatment of CRC liver metastases is a promising alternative option when surgical resection is impossible.
Patients and Methods: Between 2002 and 2006 58(33 male) patients [mean age 56(34-74) years] with LM of CRC origin were treated by RFA. In 12 patients with synchronous LM RFA was performed simultaneously with bowel resection. Percutaneous RFA was used in 46 patients with metachronous LM. All patients had R0 resection for primary tumor. Only patients with less or 5 LM (<4cm) underwent RFA. Ultrasound guided RFA used in all cases of open surgery (n=12) and in 38 cases of percutaneous RFA. CT-guided percutaneous RFA was conducted in the other 8 patients. The scheduled volume of RFA was +1cm from LM margins. RFA performed at temperature of 110 degrees centigrade with exposition not less than 10 minutes.
Results: Total number of 22 synchronous LM [mean diameter of 1.6(0.4-3.0)cm] were ablated (6 patients had solitary LM, 4 had 2 LM, 1 had 4 LM and 1 had 5 LM). There were no RFA related morbidity and mortality in the open surgery group.Total number of 62 metachronous LM [mean diameter of 3.2(0.9-4.3)cm] were ablated by percutaneous RFA (the maximal number of 4 LM in the only patient). Percutaneous RFA (n=46) resulted in intestinal perforation in one patient (2.1%), which required urgent surgery. Subcapsular haematoma developed in another patient and was treated by ultrasound guided drainage. Fever and mild leucocytosis during 2-3 post-RFA days developed in 20(43%) of 46 patients. Follow up period ranged from 5 to 37 months (median 21). All patients received adjuvant chemotherapy in XELOX regime (xeloda+oxaliplatinum). Of 58 patients 32(55.2%) are disease-free (all had 1-2 LM <2cm), while recurrence at the site of RFA was detected in 8 cases (all LM > 2.5cm) New LM developed in 16(27.6%) patients and 2 patients were presented with multiply LM and extrahepatic metastases.
Conclusion: RFA is relatively safe method for both approaches, i.e open surgery or percutaneous. Completeness of RFA necrosis is the main criterion of procedure effectiveness. The best results of RFA are expected in LM of CRC <2cm.


2007 Program and Abstracts | 2007 Posters
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