Therapeutic efficacy of combined intraoperative ablation and resection for colorectal liver metastases: an international, multi-institutional analysis.
BACKGROUND
Only 10-25% of patients presenting with colorectal liver metastases (CRLM) are amenable to hepatic resection. By combining resection and ablation, the number of patients eligible for surgery can be expanded. We sought to determine the efficacy of combined resection and ablation for CRLM.


METHODS
Between 1984 and 2009, 1,425 patients who underwent surgery for CRLM were queried from an international multi-institutional database. Of these, 125 patients underwent resection combined with ablation as the primary mode of treatment.


RESULTS
Patients presented with a median of six lesions. The median number of lesions resected was 4; the median number of lesions ablated was 1. At last follow-up, 84 patients (67%) recurred with a median disease-free interval of 15 months. While total number of lesions treated (hazard ratio (HR) = 1.47, p = 0.23) and number of lesions resected (HR = 1.18, p = 0.43) did not impact risk of intrahepatic recurrence, the number of lesions ablated did (HR = 1.36, p = 0.05). Overall 5-year survival was 30%. Survival was not influenced by the number of lesions resected or ablated (both p > 0.05).


CONCLUSIONS
Combined resection and ablation is associated with long-term-survival in a subset of patients; however, recurrence is common. The number of lesions ablated increases risk of intrahepatic recurrence but does not impact overall survival.
Department of Surgery, Johns Hopkins University School of Medicine, Harvey 611, 600N Wolfe Street, Baltimore, MD 21287, USA.
Mechteld C
MC
de Jong
Mark G
MG
van Vledder
Dario
D
Ribero
Catherine
C
Hubert
Jean-François
JF
Gigot
Michael A
MA
Choti
Richard D
RD
Schulick
Lorenzo
L
Capussotti
Cornelis H
CH
Dejong
Timothy M
TM
Pawlik
D000230:Adenocarcinoma / Q000097:blood / Q000473:pathology / Q000556:secondary*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002272:Carcinoembryonic Antigen / Q000097:blood; D017115:Catheter Ablation; D015179:Colorectal Neoplasms / Q000097:blood / Q000473:pathology*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D015996:Survival Rate; D047368:Tumor Burden
D002272:Carcinoembryonic Antigen