scholarly journals Radiofrequency ablation of unresectable colorectal liver metastases: trends in management and outcome during a decade at a single center

2015 ◽  
Vol 4 (7) ◽  
pp. 205846011558087 ◽  
Author(s):  
Knut Jørgen Labori ◽  
Anselm Schulz ◽  
Anders Drolsum ◽  
Marianne Grønlie Guren ◽  
Nils Einar Kløw ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Liver Resection ◽  
Local Recurrence ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Surgical Techniques ◽  
Hepatic Veins ◽  
Time Period ◽  
Unresectable Colorectal Liver Metastases ◽  
Portal Veins

Background Radiofrequency ablation (RFA) is widely used for treatment of colorectal liver metastases (CRLM). Purpose To evaluate the effect of increased experience in RFA of CRLM on morbidity and survival, and the trends in patient management and outcomes during the last decade. Material and Methods Hospital records of the initial 52 consecutive patients who underwent RFA (56 procedures/70 lesions) were retrospectively reviewed. The patients were divided into two groups according to time period of treatment, period I (2001–2006: n = 26) and period II (2007–2011: n = 26). Results Concomitant liver resection was performed in 15 patients in each period. Operative morbidity decreased from 47% to 19% ( P = 0.047). Most complications were found in patients who underwent a concomitant liver resection and not related to the ablation per se. Local recurrence rate decreased from 19.4% to 12.9% ( P = 0.526). At least one risk factor for recurrence was found in patients with local recurrence ( n = 11): subcapsular localization ( n = 4), tumor size >3 cm and subcapsular localization ( n = 2), and perivascular localization (portal veins/hepatic veins) ( n = 5). Median overall survival was 32 months in period I and 49 months in period II, whereas estimated 5-year survival was 19% and 36%, respectively ( P = 0.09). Adjuvant chemotherapy was given to four patients (15.4%) in period I and 13 patients (50%) in period II ( P = 0.017). Conclusion RFA alone or in combination with liver resection is a potentially curative treatment to selected patients with CRLM. Over time, the morbidity and survival have improved in RFA of CRLM. Although a possible effect of a learning curve should be taken into consideration in the appraisal of this improvement, it is more likely to be attributable to optimization of indication, development in surgical techniques, and increased use of perioperative chemotherapy.

Radiofrequency ablation of colorectal liver metastases

2019 ◽  
Vol 98 (10) ◽  
Keyword(s):  
Radiofrequency Ablation ◽  
Liver Resection ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Survival Rates ◽  
Postoperative Mortality ◽  
Disease Free Survival ◽  
Female Ratio ◽  
Liver Resections ◽  
Multi Stage

Introduction: Radical liver resection is the only method for the treatment of patients with colorectal liver metastases (CLM); however, only 20–30% of patients with CLMs can be radically treated. Radiofrequency ablation (RFA) is one of the possible methods of palliative treatment in such patients. Methods: RFA was performed in 381 patients with CLMs between 01 Jan 2001 and 31 Dec 2018. The mean age of the patients was 65.2±8.7 years. The male to female ratio was 2:1. Open laparotomy was done in 238 (62.5%) patients and the CT-navigated transcutaneous approach was used in 143 (37.5%) patients. CLMs <5 cm (usually <3 cm) in diameter were the indication for RFA. We used RFA as the only method in 334 (87.6%) patients; RFA in combination with resection was used in 36 (9.4%), and with multi-stage resection in 11 (3%) patients. We performed RFA in a solitary CLM in 170 (44.6%) patients, and in 2−5 CLMs in 211 (55.6%) patients. We performed computed tomography in each patient 48 hours after procedure. Results: The 30-day postoperative mortality was zero. Complications were present in 4.8% of transcutaneous and in 14.2% of open procedures, respectively, in the 30-day postoperative period. One-, 3-, 5- and 10-year overall survival rates were 94.8, 66.8, 43.9 and 16.6%, respectively, in patients undergoing RFA, and 90.6, 69.1, 52.8 and 39.2%, respectively, in patients with liver resections. Disease free survival was 63.2, 30.1, 18.4 and 13.1%, respectively, in the same patients after RFA, and 71.1, 33.3, 22.8 and 15.5%, respectively, after liver resections. Conclusion: RFA is a palliative thermal ablation method, which is one of therapeutic options in patients with radically non-resectable CLMs. RFA is useful especially in a non-resectable, or resectable (but for the price of large liver resection) solitary CLM <3 cm in diameter and in CLM relapses. RFA is also part of multi-stage liver procedures.

scholarly journals Long-Term Outcomes Following Hepatic Resection and Radiofrequency Ablation of Colorectal Liver Metastases

HPB Surgery ◽  
2009 ◽  
Vol 2009 ◽  
pp. 1-8 ◽  
Author(s):  
Andrew McKay ◽  
Katherine Fradette ◽  
Jeremy Lipschitz
Keyword(s):  
Radiofrequency Ablation ◽  
Local Recurrence ◽  
Liver Metastases ◽  
Hepatic Resection ◽  
Colorectal Liver Metastases ◽  
Controlled Trials ◽  
Long Term Outcomes ◽  
Randomized Controlled ◽  
Study Support

Recently some have called for randomized controlled trials comparing RFA to hepatic resection, particularly for patients with only a few small metastases. The objectives were to compare local recurrence and survival following RFA and hepatic resection for colorectal liver metastases. This was a retrospective review of open RFA and hepatic resection for colorectal liver metastases between January 1998 and May 2007. All patients who had RFA were considered to have unresectable disease. 58 patients had hepatic resection and 43 had RFA. A 5-year survival after resection was 43% compared to 23% after RFA. For patients with solitary lesions, a 5-year survival was 48% after resection and 15% after RFA. Sixty percent of patients suffered local recurrences after RFA compared to 7% after hepatic resection. RFA is inferior to resection. The results observed in this study support the consensus that RFA cannot be considered an equivalent procedure to hepatic resection.

Does conversion chemotherapy really improve survival in patients with colorectal liver metastases?

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 435-435
Author(s):  
Kozo Kataoka ◽  
Akiyoshi Kanazawa ◽  
Shigeyoshi Iwamoto ◽  
Yasuhiro Miyake ◽  
Takeshi Kato ◽  
...  
Keyword(s):  
Liver Resection ◽  
Liver Metastases ◽  
Hepatic Resection ◽  
Colorectal Liver Metastases ◽  
Liver Volume ◽  
Hepatic Metastases ◽  
Disease Free Survival ◽  
R0 Resection ◽  
Remnant Liver ◽  
Unresectable Colorectal Liver Metastases

435 Background: Recently, liver resection becomes possible by intensive chemotherapy, i.e. conversion chemotherapy, in patients with initially unresectable colorectal liver metastases (CLM). But the criteria for non-resectability varies one team to another, and there are few reports about the clinical benefit of conversion chemotherapy followed by liver resection. Methods: Our criteria for resectability of CLM depends on the size of remnant liver volume (>30%) and expected function after the removal of all metastases, regardress of number and size of CLM. From December 2007 to September 2011, 113 patients were diagnosed as CLM without extra-hepatic metastases and received chemotherapy. 47 patients were initially diagnosed as resectable and received hepatic resection after chemotherapy (resected group). 66 patients were initially diagnosed as unresectable, but 11 patients become resectable after chemotherapy (conversion group) and 55 patients remain unresectable in spite of chemotherapy (unresecetd group). We assessed the survival benefit between these 3 groups, retrospectively. Results: 110 patients received oxaliplatin-based regimen and 3 irrinotecan-based regimen. In coversion group, 8 patients received cetuximab containing regimen and 2 received bevacizumab containing regimen. 46 of 47 patients in resected group received R0 resection and 7 of 11 patients in conversion group. No serious postoperative complications were observed in resected and conversion group, but the incidence of a surgical site infection in conversion group was somewhat higher than in resected group. Median disease-free survival was significantly higher in the resected group than conversion group (16.73 months [95% CI: 7.80~25.47] and 3.83 months [95% CI: 0.35~7.31 months]) (P=0.031). And median overall survival (OS) was also higher in resected group, but not significant. In resected and conversion group, median OS was significantly higher than in unresected group. (52.20 vs 39.37 vs 20.57 months (p <0.001)). Conclusions: The recurrence rate was higher in coversion group, but conversion chemotherapy followed by hepatic resection seems to be promising and feasible strategy in initially unresectable CLM patients.

scholarly journals Surgical Options for Initially Unresectable Colorectal Liver Metastases

HPB Surgery ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-13 ◽  
Author(s):  
Irinel Popescu ◽  
Sorin Tiberiu Alexandrescu
Keyword(s):  
Liver Resection ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Palliative Treatment ◽  
Survival Rates ◽  
Portal Vein Ligation ◽  
Term Survival ◽  
Number Of Patients ◽  
Unresectable Colorectal Liver Metastases ◽  
Surgical Options

Although the frontiers of liver resection for colorectal liver metastases have broadened in recent decades, approximately 75% of these patients present with unresectable metastases at the time of their diagnosis. In the past, these patients underwent only palliative treatment, without the chance of a cure. In the previous two decades, several therapeutic strategies have been developed that render resectable those metastases that were initially unresectable, thus offering the chance of long-term survival and even a cure to these patients. The oncosurgical modalities that are available include liver resection following portal vein ligation/embolization, “two-stage” liver resection, one-stage ultrasonically guided liver resection, hepatectomy following conversion chemotherapy, and liver resection combined with thermal ablation. Moreover, in recent years, certain authors have recommended the revisiting of the concept of liver transplantation in highly selected patients with unresectable colorectal liver metastases and favorable prognostic factors. By employing such therapies, the number of patients with colorectal liver metastases who undergo a potentially curative treatment could increase to 40%. The safety profile of these approaches is acceptable (morbidity rates as high as 45%, mortality rates of less than 5%). Furthermore, the 5-year survival rates (approximately 30%) are significantly increased over those that were achieved with palliative treatment.

Reappraisal of the Risks and Benefits of Major Liver Resection in Patients With Initially Unresectable Colorectal Liver Metastases

2012 ◽  
Vol 256 (5) ◽  
pp. 746-754 ◽  
Author(s):  
François Cauchy ◽  
Béatrice Aussilhou ◽  
Safi Dokmak ◽  
David Fuks ◽  
Sébastien Gaujoux ◽  
...  
Keyword(s):  
Liver Resection ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Major Liver Resection ◽  
Risks And Benefits ◽  
Unresectable Colorectal Liver Metastases
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