title: Hepatectomy for recurrent colorectal liver metastases after radiofrequency ablation.
abstract: BACKGROUND
  The results of surgery for recurrent colorectal liver metastases (CLM) after radiofrequency ablation (RFA) have not been evaluated.
  
  
  METHODS
  From 1993 to 2009, data on patients who underwent resection or RFA for recurrent CLM were collected prospectively. Inclusion criteria for this study were RFA as initial treatment for CLM and resection of recurrent CLM after RFA. Postoperative results and oncological outcomes were analysed.
  
  
  RESULTS
  Twenty-eight patients (median number of tumours 1 (1-3), median size 2·8 (2·0-4·0) cm) met the inclusion criteria. Of these, 22 had recurrence at the site of RFA only, two developed new lesions, whereas four had both recurrent and de novo metastases. At the time of resection, patients had a median of 1 (1-13) CLM with a median maximum tumour diameter of 5·0 (1·8-11·0) cm, significantly larger than at the time of RFA (P = 0·021). Ninety-day postoperative morbidity and mortality rates were 46 per cent (13 of 28) and 7 per cent (2 of 28) respectively. After a median follow-up of 35 (0-70) months, 3-year overall and disease-free survival rates calculated by Kaplan-Meier analysis were 60 and 29 per cent respectively. Plasma carcinoembryonic antigen level over 5 ng/ml at the time of resection and a rectal primary tumour were associated with worse survival (P = 0·041 and P = 0·021 respectively).
  
  
  CONCLUSIONS
  Resection for recurrence after RFA is associated with significant morbidity and modest long-term benefit.
authors.affiliation: Department of Surgical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
authors.forename: A
authors.initials: A
authors.lastname: Brouquet
authors.forename: J-N
authors.initials: JN
authors.lastname: Vauthey
authors.forename: B D
authors.initials: BD
authors.lastname: Badgwell
authors.forename: E M
authors.initials: EM
authors.lastname: Loyer
authors.forename: H
authors.initials: H
authors.lastname: Kaur
authors.forename: S A
authors.initials: SA
authors.lastname: Curley
authors.forename: E K
authors.initials: EK
authors.lastname: Abdalla
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017115:Catheter Ablation / Q000379:methods* / Q000401:mortality; D015179:Colorectal Neoplasms; D005260:Female; D006498:Hepatectomy / Q000379:methods* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality*; D011446:Prospective Studies; D016896:Treatment Outcome