title: Use of intraoperative ablation as an adjunct to surgical resection in the treatment of recurrent colorectal liver metastases.
abstract: OBJECTIVE
  To evaluate the role of intraoperative ablation as an adjunct to resection in patients with recurrent colorectal liver metastases (rCLM).
  
  
  METHODS
  All patients undergoing curative-intent reoperative surgery for rCLM from 1992 to 2009 at a tertiary cancer center were included. Overall survival (OS) and recurrence-free survival (RFS) were compared between patients treated with resection alone or in combination with ablation.
  
  
  RESULTS
  A total of 112 reoperative hepatectomies were performed, of which 16 were combined with ablation. The proportion of patients treated with resection and ablation increased from 0% to 41%. Patients undergoing resection and ablation had a greater tumor burden (median, 4 vs. 1, p < 0.0001) and higher baseline clinical risk scores (median, 3 vs. 2, p = 0.065) than patients undergoing resection alone. Patients undergoing resection and ablation had lower intraoperative blood loss than patients undergoing resection alone (344 vs. 877 ml, p = 0.018). Five-year OS from the time of surgery was 48.6%. In multivariable analysis, there was no significant difference in OS or RFS based on the treatment modality.
  
  
  CONCLUSIONS
  In patients with rCLM, the use of intraoperative ablation can extend the limits of surgical resection in patients with disease that might otherwise not be amenable to complete resection.
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, 444 E 68th Street, Room C887, New York, NY 10065, USA.
authors.forename: Anand
authors.initials: A
authors.lastname: Govindarajan
authors.forename: Dean
authors.initials: D
authors.lastname: Arnaoutakis
authors.forename: Michael
authors.initials: M
authors.lastname: D'Angelica
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Allen
authors.forename: Ronald P
authors.initials: RP
authors.lastname: DeMatteo
authors.forename: Leslie H
authors.initials: LH
authors.lastname: Blumgart
authors.forename: William R
authors.initials: WR
authors.lastname: Jarnagin
authors.forename: Yuman
authors.initials: Y
authors.lastname: Fong
mesh_terms: D017115:Catheter Ablation / Q000379:methods*; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007432:Intraoperative Period; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D009518:New York / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome