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Original Investigation |

Long-term Outcomes Following Tumor Ablation for Treatment of Bilateral Colorectal Liver Metastases

Paul J. Karanicolas, MD, PhD1,3; William R. Jarnagin, MD1; Mithat Gonen, PhD2; Scott Tuorto, BA1; Peter J. Allen, MD1; Ronald P. DeMatteo, MD1; Michael I. D’Angelica, MD1; Yuman Fong, MD1
[+] Author Affiliations
1Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
2Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York
3Department of Surgery, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
JAMA Surg. 2013;148(7):597-601. doi:10.1001/jamasurg.2013.1431.
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Importance  Ablative therapies extend the capability of delivering potentially curative treatment for bilateral hepatic colorectal metastases.

Objective  To compare the long-term effectiveness of ablation with that of resection in patients with bilateral hepatic colorectal metastases.

Design  Review of a prospective database of 2123 operative cases of hepatic colorectal metastases.

Setting  A large institution with expertise in ablation and resection.

Patients  Patients with bilateral colorectal liver metastases undergoing operation with a curative intent. A total of 141 patients had been treated with bilateral resection (BR) and 95 had undergone ablation.

Interventions  Radiofrequency or microwave ablation alone or in combination with resection (A/R) compared with BR.

Main Outcomes and Measures  We compared tumor characteristics and operative and postoperative outcomes using χ2 or Wilcoxon tests as appropriate and assessed overall survival differences between the 2 groups using the log-rank test.

Results  During the study, 141 patients were treated with BR and 95 patients with A/R. The A/R group was a significantly poorer prognostic group than the BR group as judged by the Clinical Risk Score (P < .01). There was no difference in median operative time (A/R: 280 minutes, BR: 282 minutes; P = .52), but a lower blood loss (A/R: 300 mL, BR: 500 mL; P < .01) and a shorter length of stay (A/R: 7 days, BR: 9 days; P < .01) was achieved in the A/R group. Long-term outcome was not significantly different between the groups (5-year overall survival, A/R: 56%, BR: 49%; P = .16).

Conclusions and Relevance  Treatment of bilateral, multiple hepatic metastases with combined resection and ablation was associated with improved perioperative outcomes without compromising long-term survival compared with bilateral resection. Ablative therapies extend the capability of delivering potentially curative treatment for bilateral hepatic colorectal metastases.

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Figures

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Figure 1.
Risk Score Distribution

Distribution of Clinical Risk Score among patients treated with bilateral resection or ablation with or without resection (P = .002).

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Figure 2.
Probability of Survival

Overall survival in patients treated with bilateral resection or ablation with or without resection (P = .16).

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