title: Combined liver surgery and RFA for patients with gastroenteropancreatic endocrine tumors presenting with more than 15 metastases to the liver.
abstract: OBJECTIVE
  The aim of this study was to report the feasibility and early survival results of liver metastases (LM) resection combining cytoreductive surgery and radiofrequency ablation (RFA) during a one-step procedure, in patients presenting more than 15 bilateral LM from well-differentiated endocrine carcinoma. It is an extensive application of the current guidelines.
  
  
  METHODS
  In this retrospective review of a prospectively collected database, we used a combination of hepatectomy to treat large or contiguous LM, and extensively used multiple RFA to treat the remaining LM which were smaller than 2.5 cm. Patients were selected based on a low natural tumor burden slope, and the technical feasibility of treating all the detectable LM.
  
  
  RESULTS
  From January 2002 to May 2007, 16 patients with a median of 23 LM per patient (mean number: 25.7 + or -12; range16-89) underwent this procedure. A mean of 15 + or - 9 LM per patient were surgically removed and a mean of 12 + or - 8 (median of 10) LM per patient were RF ablated. No mortality occurred. Morbidity was observed in 11 patients (69%). The 3-year overall survival and disease-free survival rates were similar to those observed in our preliminary series of 47 hepatectomized patients with a median of 7 LM per patient.
  
  
  CONCLUSIONS
  This new one-step combined technique allowed us to apply an "upgraded" therapeutic approach to a selection of patients presenting a median of 23 LM per patient and to improve their prognosis, putting it on par with that obtained by conventional hepatectomy.
authors.affiliation: Institut Gustave Roussy, 39 Rue Camille Desmoulins, 94805 Villejuif, Cédex, France. elias@igr.fr
authors.forename: D
authors.initials: D
authors.lastname: Elias
authors.forename: D
authors.initials: D
authors.lastname: Goéré
authors.forename: G
authors.initials: G
authors.lastname: Leroux
authors.forename: C
authors.initials: C
authors.lastname: Dromain
authors.forename: S
authors.initials: S
authors.lastname: Leboulleux
authors.forename: Th
authors.initials: T
authors.lastname: de Baere
authors.forename: M
authors.initials: M
authors.lastname: Ducreux
authors.forename: E
authors.initials: E
authors.lastname: Baudin
mesh_terms: D000328:Adult; D017115:Catheter Ablation; D003131:Combined Modality Therapy; D005240:Feasibility Studies; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000473:pathology; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000556:secondary* / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000473:pathology; D012189:Retrospective Studies; D016019:Survival Analysis