title: Open surgical is superior to percutaneous access for radiofrequency ablation of hepatic metastases.
abstract: OBJECTIVE
  This study was designed to determine the best approach to radiofrequency ablation (RFA) in the liver.
  
  
  METHODS
  From a total of 41 procedures, 37 patients with 47 tumors were treated with RFA for metastatic disease. Indications included colorectal cancer (n=28, 68%), neuroendocrine tumors (n=2, 5%), gynecological primaries (n=4, 10%), pancreatic/duodenal cancer (n=2, 5%), and miscellaneous entities (n=5, 12%). Mean follow-up period was 18 (median, 18) months. All ways of approach to RFA were applied: percutaneous was chosen in 17 (41.5%), laparoscopic and hand-assisted laparoscopic in 5 (12.2%), and open surgical in 19 cases (46.3%), and in 10 cases, RFA was combined with hepatic resection. The average maximum tumor size was 2.3 (range, 0.8-6) cm, and the mean number of nodules treated per patient in a single session was 1.3 (range, 1-3).
  
  
  RESULTS
  Overall survival was 59.5% at 2 years, recurrence-free 2-year survival was 12.6%, local tumor recurrence rate was 34%, and overall recurrence was 75.6%. Local tumor recurrence and disease-free survival were significantly improved in the open surgically treated patients compared with the percutaneous treatment group (15.8% [n=3] vs. 58.8% [n=10] and 11.5 vs. 7.9 months, p<0.01 [chi2 test] and p<0.05 [log-rank test], respectively).
  
  
  CONCLUSIONS
  Open surgical approach is superior to percutaneous access for RFA in metastatic hepatic disease.
authors.affiliation: Department of General, Visceral, and Transplantation Surgery, Charité Virchow-Clinic, Augustenburger Pl. 1, 13353, Berlin, Germany. robert_m.eisele@charite.de
authors.forename: Robert M
authors.initials: RM
authors.lastname: Eisele
authors.forename: Ulf
authors.initials: U
authors.lastname: Neumann
authors.forename: Peter
authors.initials: P
authors.lastname: Neuhaus
authors.forename: Guido
authors.initials: G
authors.lastname: Schumacher
mesh_terms: D000368:Aged; D017115:Catheter Ablation / Q000379:methods*; D015179:Colorectal Neoplasms / Q000473:pathology; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D011859:Radiography; D012189:Retrospective Studies