Role of intraoperative thermoablation combined with resection in the treatment of hepatic metastasis from colorectal cancer Journal Article
| Authors: | Kornprat, P.; Jarnagin, W. R.; DeMatteo, R. P.; Fong, Y.; Blumgart, L. H.; D'Angelica, M. |
| Article Title: | Role of intraoperative thermoablation combined with resection in the treatment of hepatic metastasis from colorectal cancer |
| Abstract: | Hypothesis: Thermoablation, either cryosurgical ablation (CSA) or radiofrequency ablation (RFA), combined with resection is effective in the treatment of extensive bilobar colorectal metastasis. Design: Retrospective analysis of a prospective hepatobiliary surgical database. Setting: Tertiary care referral center. Patients: Consecutive patients with colorectal hepatic metastases selected for surgical treatment. Interventions: All patients underwent hepatic resection combined with CSA or RFA. Main Outcome Measures: Local recurrence rates at ablation sites, overall survival, disease-free survival, and hepatic disease-free survival. Results: Between January 1, 1998, and December 31, 2003, 665 patients with colorectal metastases underwent hepatic resection. Of these, 39 (5.9%) had additional intraoperative thermoablative procedures (19 RFA, 20 CSA). There was 1 (3%) postoperative death not directly associated with the ablation, and the total morbidity rate was 41% (16 of 39). No RFA-related complication occurred; however, 3 patients developed an abscess at cryoablation sites. Actuarial 3-year survival was 47% for the entire group, with a median follow-up of 21.1 months (range, 0.5-71.4 months). The median diseasefree survival was 12.3 months (range, 8.4-16.2 months). Overall, the local in situ recurrence rate according to number of ablated tumors was 14% for RFA and 12% for CSA. Tumor size correlated directly with recurrence (P=.02) in RFA-treated lesions. Conclusions: Ablation combined with hepatic resection is rarely necessary or applicable. However, in selected patients whose tumors were otherwise unresectable, additional use of ablation allows effective clearance of disease. In these patients with extensive bilobar disease, recurrence rates are high, but long-term survival is encouraging and may be improved with aggressive postoperative chemotherapy. ©2007 American Medical Association. All rights reserved. |
| Keywords: | adult; clinical article; aged; middle aged; survival analysis; cancer surgery; retrospective studies; overall survival; cancer recurrence; liver neoplasms; disease free survival; combined modality therapy; recurrence risk; intraoperative care; colorectal cancer; tumor volume; retrospective study; cancer mortality; colorectal neoplasms; liver metastasis; hepatectomy; radiofrequency ablation; catheter ablation; cryosurgery; abscess |
| Journal Title: | Archives of Surgery |
| Volume: | 142 |
| Issue: | 11 |
| ISSN: | 0004-0010 |
| Publisher: | American Medical Association |
| Date Published: | 2007-11-01 |
| Start Page: | 1087 |
| End Page: | 1092 |
| Language: | English |
| DOI: | 10.1001/archsurg.142.11.1087 |
| PUBMED: | 18025338 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 20" - "Export Date: 17 November 2011" - "CODEN: ARSUA" - "Source: Scopus" |
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