title: Surgical resection for local recurrence after radiofrequency ablation for colorectal liver metastasis is more extensive than primary resection.
abstract: OBJECTIVE
  As a minimally invasive modality, radiofrequency ablation (RFA) has been increasingly applied not only for the treatment of hepatocellular carcinoma, but also for that of colorectal liver metastasis (CLM). However, RFA for CLM has been shown to be associated with a high local recurrence rate, and no optimal treatment for RFA failure has been established yet. The aim of this study was to evaluate the feasibility and outcome of surgical resection for local recurrence after RFA.
  
  
  METHODS
  A retrospective study of 17 patients, who underwent surgery for local recurrence after RFA for resectable CLM, was carried out. The surgical procedures involved in the actual surgery were compared with those envisioned for the primary resection if RFA had not been selected.
  
  
  RESULTS
  Surgical resection for RFA recurrence was more invasive than the envisioned surgical procedure in 10 cases (58%). In addition, the proportions of cases that required technically demanding procedures among the patients receiving surgery for RFA recurrence were higher than those in envisioned operations; major hepatectomy, eight cases [47%] versus two cases [12%] (p<0.0205); excision and/or reconstruction of the major hepatic veins, three cases [18%] versus zero case [0%] (p=0.035); excision of diaphragm: three cases [18%] versus zero case [0%] (p=0.035). The 1-, 3- and 5-year overall survival rates were 92%, 45% and 45%, respectively.
  
  
  CONCLUSIONS
  Surgical resection for RFA recurrence for CLM required more invasive and technically demanding procedures. Thus, RFA for CLM should be limited to unresectable cases, and patients with resectable CLM should be thoroughly advised not to undergo RFA, but rather surgical resection.
authors.affiliation: Department of Surgery, Hepato-Biliary-Pancreatic Surgery Division, Graduate School of Medicine, University of Tokyo , Tokyo , Japan.
authors.forename: Yoshikuni
authors.initials: Y
authors.lastname: Kawaguchi
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Hasegawa
authors.forename: Akio
authors.initials: A
authors.lastname: Saiura
authors.forename: Rihito
authors.initials: R
authors.lastname: Nagata
authors.forename: Michiro
authors.initials: M
authors.lastname: Takahashi
authors.forename: Masaru
authors.initials: M
authors.lastname: Oba
authors.forename: Junichi
authors.initials: J
authors.lastname: Kaneko
authors.forename: Taku
authors.initials: T
authors.lastname: Aoki
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sakamoto
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Sugawara
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Makuuchi
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kokudo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017115:Catheter Ablation; D015179:Colorectal Neoplasms / Q000473:pathology*; D003964:Diaphragm / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000379:methods; D006503:Hepatic Veins / Q000601:surgery; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D010347:Patient Care Planning; D012189:Retrospective Studies; D016879:Salvage Therapy; D015996:Survival Rate