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

Karanicolas PJ, Jarnagin WR, Gonen M, et al. — Wed, 08 May 2013 00:00:00 GMT

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.

To Ablate or Not to Ablate?: That Is the Question Comment on “Tumor Ablation Outcomes Following Tumor Ablation for Treatment of Bilateral Colorectal Liver Metastases” To Ablate or Not to Ablate?

Sherman KL, Bentrem DJ. — Wed, 08 May 2013 00:00:00 GMT

Karanicolas and colleagues report a retrospective single-institution experience of combined tumor ablation and resection vs resection alone in the treatment of a highly selected group of patients with bilateral hepatic colorectal metastases. They identified that patients treated with a combined approach had decreased operative blood loss and length of stay; however, they had similar operative time, 30-day mortality, and 5-year overall survival. The authors concluded that treatment with a combined approach was associated with improved perioperative outcomes, although similar 5-year overall survival.

JAMA Surgery: Hepatobiliary Cancer Topic Collection

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

To Ablate or Not to Ablate?: That Is the Question Comment on “Tumor Ablation Outcomes Following Tumor Ablation for Treatment of Bilateral Colorectal Liver Metastases” To Ablate or Not to Ablate?