Radiofrequency ablation versus resection for resectable colorectal liver metastases: time for a randomized trial?
BACKGROUND
Surgical resection is the gold standard in the treatment of resectable colorectal liver metastases (CRLM). In several centers, resection is being replaced by radiofrequency ablation (RFA), even though there is no evidence yet from randomized trials to support this. The aim of this study was to critically review the oncological evidence for and against the use of RFA for resectable CRLM.


METHODS
An exhaustive review of RFA of colorectal metastases was carried out.


RESULTS
Five-year survival data after RFA for resectable CRLM are not available. Percutaneous RFA is associated with worse local control, worse staging, and a small risk of electrode track seeding when compared with resection (level V evidence). For tumors </=3 cm, local control after surgical RFA is equivalent to resection, especially if applied by experienced physicians to nonperivascular tumors (level V evidence). There is indirect evidence for profoundly different biological effects of RFA and resection.


CONCLUSIONS
A subgroup of patients has been identified for whom local control after RFA might be equivalent to resection. Whether this is true, and whether this translates into equivalent survival, remains to be proven. The time has come for a randomized trial.
Mulier
Stefaan
S
Department of Surgery, Leopold Park Clinic, Froissartstraat 34, B-1040, Brussels, Belgium.
Ni
Yicheng
Y
Jamart
Jacques
J
Michel
Luc
L
Marchal
Guy
G
Ruers
Theo
T
D017115:Catheter Ablation; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D003131:Combined Modality Therapy; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D009367:Neoplasm Staging; D011379:Prognosis; D015642:Radiology, Interventional; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome