scholarly journals Resection or radiofrequency ablation of colorectal liver metastasis

2014 ◽  
Vol 71 (6) ◽  
pp. 542-546 ◽  
Author(s):  
Damir Jasarovic ◽  
Dragos Stojanovic ◽  
Nebojsa Mitrovic ◽  
Dejan Stevanovic
Keyword(s):  
Overall Survival ◽  
Radiofrequency Ablation ◽  
Liver Metastasis ◽  
Liver Metastases ◽  
Colorectal Liver Metastasis ◽  
Colorectal Liver Metastases ◽  
Disease Free Survival ◽  
University Hospital ◽  
Term Survival ◽  
Cancer Metastases

Background/Aim. Liver resection is the treatment of choice for solitary colorectal liver metastases in suitable candidates. Recently, radiofrequency ablation (RFA) has become a very popular procedure in the treatment of liver metastases. The aim of this study was to compare outcomes in patients with solitary colorectal liver metastasis who had been subjected to resection or ablation. Methods. In this retrospective study we analyzed and compared patients with solitary colorectal liver metastases treated by resection or ablation in the University Hospital Centre ?Dr Dragisa Misovic? in Belgrade from January 2002 until December 2009. Results. In this study 94 (67.1%) patients underwent resection whereas 46 (32.9%) patients underwent RFA. Most of the resected patients (59.6%) required major hepatectomy. The median follow-up time was 28.4 months. Tumor ablation was a significant predictor of the overall survival (p = 0.002; OR 3.75; 95% CI 1.696-8.284). Our study demonstrated longer disease free-survival in the group of resected patients compared to the RFA group (37.6 vs 22.3 months, p = 0.073). The median overall survival was 56.3 months for patients who underwent resection vs 25.1 months for those in the RFA group (p = 0.005). Conclusion. This study shows that the patients with solitary hepatic colorectal cancer metastases should be considered for hepatic resection whenever it is feasible, because this procedure provides superior long-term survival as compared to radiofrequency ablation.

scholarly journals SURGICAL OUTCOMES AND PROGNOSTIC FACTORS IN PATIENTS WITH SYNCHRONOUS COLORECTAL LIVER METASTASES

2014 ◽  
Vol 51 (1) ◽  
pp. 4-9 ◽  
Author(s):  
Rafael FONTANA ◽  
Paulo HERMAN ◽  
Vincenzo PUGLIESE ◽  
Marcos Vinicius PERINI ◽  
Fabricio Ferreira COELHO ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Prognostic Factors ◽  
Liver Metastasis ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Disease Free Survival ◽  
Term Survival ◽  
Free Survival ◽  
Disease Free

Context Colorectal cancer is the second most prevalent cancer worldwide, and the liver is the most common site of metastases. Surgical resection of colorectal liver metastases provides the sole possibility of cure and the best odds of long-term survival. Objectives To describe surgical outcomes and identify features associated with disease prognosis in patients submitted to synchronous colorectal cancer liver metastasis resection. Methods Retrospective study of 59 patients who underwent surgery for synchronous colorectal cancer liver metastasis. Actuarial survival and disease-free survival were assessed, depending on the prognostic variable of interest. Results Postoperative mortality and morbidity rates were 3.38% and 30.50% respectively. Five-year disease-free survival was estimated at 23.96%, and 5-year overall survival, at 38.45%. Carcinoembryonic antigen levels ≥50 ng/mL and presence of three or more liver metastasis were limiting factors for disease-free survival, but did not affect late survival. No patient with liver metastases and extrahepatic disease had disease-free interval longer than 20 months, but this had no significance or impact on long-term survival. None of the prognostic factors assessed had an impact on late survival, although no patients with more than three liver metastases survived beyond 40 months. Conclusions Although Carcinoembryonic antigen levels and number of metastases are prognostic factors that limit disease-free survival, they had no impact on 5-year survival and, therefore, should not determine exclusion from surgical treatment. Resection is the best treatment option for synchronous colorectal liver metastases, and even for patients with multiple metastases, large tumors and extrahepatic disease, it can provide long-term survival rates over 38%.

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.

Meta-Analysis of Long-Term Outcomes in Patients with Colorectal Liver Metastases Undergoing Hepatectomy with or without Radiofrequency Ablation

2018 ◽  
Vol 84 (12) ◽  
pp. 1913-1923
Author(s):  
Li Long ◽  
Li Wei ◽  
Wu Hong
Keyword(s):  
Radiofrequency Ablation ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Meta Analysis ◽  
Disease Free Survival ◽  
Medical Subject Headings ◽  
Long Term Outcomes ◽  
Hazard Ratios ◽  
Long Term Prognosis

This meta-analysis aimed to compare the long-term prognosis of patients with colorectal liver metastases undergoing liver resection (LR) with or without radiofrequency ablation (RFA). A systematic search was performed using both medical subject headings and truncated word searches to identify all comparative studies published on this topic. The primary outcomes were postoperative overall survival (OS) and disease-free survival (DFS). Pooled hazard ratios (HR) with 95 per cent confidence intervals (95% CI) were calculated. A total of 10 studies which included 3900 patients were finally enrolled in the meta-analysis. Patients treated by LR gained better OS (HR: 2.07, 95% CI: 1.82–2.37) and DFS (HR: 1.91, 95% CI: 1.70–2.15) than those patients treated by LR 1 RFA, after pooling unadjusted HRs from the 10 studies. Five studies provided the data of adjusted HR. The pooled results showed that patients in the LR 1 RFA group had shorter OS (HR: 1.66, 95% CI: 1.18–2.32, P = 0.004) but similar DFS (HR: 1.36, 95% CI: 0.99–1.88) compared with patients in the LR group. Our meta-analysis showed that colorectal liver metastases patients who underwent LR gained better long-term outcomes compared with patients undergoing LR 1 RFA. However, after adjusting confounders, LR 1 RFA achieved comparable DFS with LR alone.

scholarly journals A metastatic colorectal carcinoma: A curative approach?

2014 ◽  
Vol 61 (2) ◽  
pp. 47-49
Author(s):  
Nadezda Basara
Keyword(s):  
Liver Metastasis ◽  
Liver Metastases ◽  
Colorectal Liver Metastasis ◽  
Randomised Trial ◽  
Increase Response Rate ◽  
Term Survival ◽  
Exon 2 ◽  
Long Term Survival ◽  
Response To Chemotherapy

Background: Unresectable colorectal liver metastases can be resected after response to chemotherapy. The use of neoadjuvant chemotherapy with or without targeted monoclonal antibodies increases the proportion of resectable liver metastasis and conferred a long term survival of 40%. Methods: The current ongoing studies regarding neodjuvant treatment strategies aiming to increase a proportion of patients with resectable liver metastases is going to be presented. Results: Perioperative chemotherapy with FOLFOX4 is compatible with major liver surgery and reduces the risk of events of progression free survival in resected patients. The results of the CELIM study confirm a favourable long-term survival for patients with initially suboptimal or unresectable colorectal liver metastasis who respond to conversion therapy and undergo secondary resection. The New EPOC randomised trial does not support the addition of cetuximab to chemotherapy and surgery for operable colorectal liver metastasis in KRAS exon 2 wild-type patients. Conclusion: The ability of anti-epidermal growth factor receptor agents to increase response rate and resection when added to chemotherapy has been clearly shown in a number of trials. The resection rates are higher with chemotherapy plus Cetuximab, in general, a conversion is contributes to the better overall survival.

scholarly journals Prognostic Factors Affecting Survival of Patients after Liver Resection Due to Colorectal Liver Metastases

2016 ◽  
Vol 70 (3) ◽  
pp. 133-139
Author(s):  
Stefan Petrovski ◽  
Elena Arabadzhieva ◽  
Saso Bonev ◽  
Dimitar Bulanov ◽  
Valentin Popov ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Liver Resection ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Prognostic Significance ◽  
Radical Resection ◽  
University Hospital ◽  
Tumor Type ◽  
Term Survival ◽  
Localization Of Metastases

Abstract Introduction. Colorectal liver metastases have a poor prognosis and only 2% have an average 5-year survival if left untreated. In recent decades there has been a development in the diagnosis, treatment and palliative treatment of patients with colorectal liver metastases, and despite radical resection the average five-year survival is between 25% and 44%. Aim. To explore the experience of the Clinic in the treatment of colorectal liver metastases, comparing it with data from the literature and based on the comparison to determine the prognostic factors that affect survival after radical surgical treatment of patients. Methods. A retrospective study was conducted at the Clinic of General and Hepato-pancreatic Surgery at the University Hospital “Aleksandrovska”-Sofia. The study comprised the period between 01.01.2006 to 31.12.2015. It included a total of 239 cases, of whom: 179 patients underwent radical interventions, 5 palliative and 55 patients underwent explorative interventions due to liver metastases. Clinical and pathological materials were analyzed using SPSS-19 to determine the prognostic significance of a number of factors in relation to the survival: gender, age, type and localization of metastases, postoperative stage of the primary tumor, type and volume of liver resection, extrahepatic metastases, preoperative values of CEA, postoperative values (AST, ALT). Results. Factors that correlated with lower survival type: metastases (synchronous or metachronus), localization of metastases (uni-or bilobar), presence of the regional lymph node metastases and metastases to other distant organs and the impossibility of radical resection of liver were statistically significant with multivariant analysis. Elevated preoperative value of CEA, the value of hemoglobin and stage IV disease also affected the survival of patients. Conclusion. In patients with colorectal liver metastases only resection has potentially curative character. The surgical strategy for resection in context of increasing the percentage of patients with resectable potential is the only possible factor for long-term survival.

Determination of the electrical conductivity of human liver metastases: impact on therapy planning in the radiofrequency ablation of liver tumors

2016 ◽  
Vol 58 (2) ◽  
pp. 164-169 ◽  
Author(s):  
Urte Zurbuchen ◽  
Franz Poch ◽  
Ole Gemeinhardt ◽  
Martin E Kreis ◽  
Stefan M Niehues ◽  
...  
Keyword(s):  
Electrical Conductivity ◽  
Radiofrequency Ablation ◽  
Liver Metastasis ◽  
Liver Metastases ◽  
Liver Tissue ◽  
Colorectal Liver Metastases ◽  
Liver Tumors ◽  
Tissue Temperature ◽  
Specific Electrical Conductivity

Background Radiofrequency ablation is used to induce thermal necrosis in the treatment of liver metastases. The specific electrical conductivity of a liver metastasis has a distinct influence on the heat formation and resulting tumor ablation within the tissue. Purpose To examine the electrical conductivity σ of human colorectal liver metastases and of tumor-free liver tissue in surgical specimens. Material and Methods Surgical specimens from patients with resectable colorectal liver metastases were used for measurements (size of metastases <30 mm). A four-needle measuring probe was used to determine the electrical conductivity σ of human colorectal liver metastasis (n = 8) and tumor-free liver tissue (n = 5) in a total of five patients. All measurements were performed at 470 kHz, which is the relevant frequency for radiofrequency ablation. The tissue temperature was also measured. Hepatic resections were performed in accordance with common surgical standards. Measurements were performed in the operating theater immediately after resection. Results The median electrical conductivity σ was 0.57 S/m in human colorectal liver metastases at a median temperature of 35.1℃ and 0.35 S/m in tumor-free liver tissue at a median temperature of 34.9℃. The electrical conductivity was significantly higher in tumor tissue than in tumor-free liver tissue ( P = 0.005). There were no differences in tissue temperature between the two groups ( P = 0.883). Conclusion The electrical conductivity is significantly higher in human colorectal liver metastases than in tumor-free liver tissue at a frequency of 470 kHz.

Outcome of patients with colorectal liver metastasis: Analysis of 1,613 consecutive cases.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14000-e14000
Author(s):  
Jianmin Xu ◽  
Dexiang Zhu ◽  
Li Ren ◽  
Ye Wei ◽  
Yunshi Zhong
Keyword(s):  
Survival Rate ◽  
Liver Metastasis ◽  
Liver Metastases ◽  
Median Survival ◽  
Colorectal Liver Metastasis ◽  
Primary Tumor ◽  
Systemic Chemotherapy ◽  
Term Survival ◽  
Different Types ◽  
Hepatic Arterial Chemotherapy

e14000 Background: To evaluate the long-time outcome of patients with colorectal liver metastasis (CRLM) undergoing different types of therapy and identify factors associated with prognosis. Methods: From 2000 to 2010, a total of 1,613 patients with CRLM were identified in Zhongshan Hospital. Clinicopathological and outcome data were collected and analyzed by univariate and multivariate analyses. Results: Of 1,613 patients the median survival was 23.1 months and the five-year survival rate was 23%. Synchronous liver metastasis (SLM), female, grade III-IV, T4 and N + of primary tumor, bilobar disease, number of liver metastases ≥ 4, size of largest liver metastases ≥ 5 cm, CEA ≥5 ng/ml and CA19-9 ≥ 37u/ml were the predictors of adverse outcome using univariate analysis. The median survival and five-year survival rate for patients after resection of liver metastases was 49.8 months and 47%, compared with 22.2 months and 19% for those after systemic chemotherapy alone, 19.0 months and 13% for those after hepatic arterial chemotherapy alone, 22.8 months and 10% for those after systemic chemotherapy combined with hepatic arterial chemotherapy, and 28.5 months and 6% for those after local regional treatment alone (p< 0.010). In addition, patients without treatment had the poorest survival rate (9.6 months and 0%). 64 initially unresectable patients underwent surgery after convertible therapy and had a median survival of 36.9 months and a five-year survival of 30%, which was better than that of unresectable patients who did not undergo surgery (18.2 months and 10%). By multivariate analysis, SLM, poorly differentiated primary tumor, number of liver metastases ≥ 4, size of largest liver metastases ≥ 5 cm, and no surgical treatment of liver metastases were found to be independent predictors of poor survival. Conclusions: Patients with CRLM could get long-term survival benefit from different types of therapy, and resection of resectable and initially unresectable liver metastases was the optimal strategy. The disease-free interval from primary to liver metastases, the differentiation of the primary tumor, the number and size of liver metastases and the types of therapy used to treat liver metastases were independent prognostic factors.

Treatment of colorectal liver metastasis: Comparison of radiofrequency ablation and hepatic resection.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 637-637
Author(s):  
Min Yong Yoon ◽  
Hyung Ook Kim
Keyword(s):  
Overall Survival ◽  
Radiofrequency Ablation ◽  
Liver Metastases ◽  
Hepatic Resection ◽  
Recurrence Rate ◽  
Colorectal Liver Metastases ◽  
Survival Rates ◽  
Disease Stage ◽  
Resection Group ◽  
Serum Carcinoembryonic Antigen

637 Background: Hepatic resection is the mainstay of management for colorectal liver metastases. But, the treatment for colorectal liver metastases requires a multidisciplinary therapeutic strategy. The aim of this study was to compare recurrence and survival rates for patients treated with hepatic resection or radiofrequency ablation (RFA) for colorectal liver metastases. Methods: Between July 2002 and September 2010, 52 patients underwent hepatic resection and 58 underwent RFA for synchronous or metachronous colorectal liver metastases. A retrospective analysis was performed. Patients with extrahepatic metastases were excluded. Results: The two groups had similar mean age, comorbid medical conditions, primary disease stage, and number of tumors. Preoperative median serum carcinoembryonic antigen (CEA) level was significantly higher in the resection group (13.8 ng/mL vs. 3.1 ng/mL; p = 0.001). Median diameter of main tumors was significantly greater in resection group (4.1 cm vs. 2.0 cm; p = 0.002). Recurrence rate after treatment was 46.2% (24/52) in the resection group and 70.7% (41/58) in the RFA group. Marginal recurrence after resection or RFA was observed in 7.6% (4/52) and 46.6% (27/58), respectively (p = 0.003). Median recurrence free survival (28.0 vs. 12.0 months; p = 0.007) and median overall survival (43.0 vs. 26.0 months; p = 0.023) were significantly longer in the resection group. Conclusions: Hepatic resection is the treatment of choice for colorectal liver metastases. RFA for colorectal liver metastases was associated with higher marginal recurrence rate and shorter recurrence free and overall survival.

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