title: Combined ablation and resection (CARe) as an effective parenchymal sparing treatment for extensive colorectal liver metastases.
abstract: BACKGROUND
  Combined intra-operative ablation and resection (CARe) is proposed to treat extensive colorectal liver metastases (CLM). This multicenter study was conducted to evaluate overall survival (OS), local recurrence-free survival (LRFS), hepatic recurrence-free survival (HRFS) and progression-free survival (PFS), to identify factors associated with survival, and to report complications.
  
  
  METHODS
  Four centers combined retropectively their clinical experiences regarding CLM treated by CARe. CLM characteristics, pre- and post-operative chemotherapy regimens, surgical procedures, complications and survivals were analyzed.
  
  
  RESULTS
  Of the 288 patients who received CARe, 210 (73%) had synchronous and 255 (88%) had bilateral CLM. Twenty-two patients (8%) had extrahepatic disease. Median follow-up was 3.17 years (95%CI 2.83-4.08). Median OS was 3.33 years (95%CI 3.08-4.17) and 5-year OS was 37% (95%CI 29-45). One- and 5-year LRFS from ablated lesions were 87.9% (95%CI 83.3-91.2) and 78.0% (95%CI 71-83), respectively. Median HRFS and PFS were 14 months (95%CI 11-18) and 9 months (95%CI 8-11), respectively. One hundred patients experienced complications: 29 grade I, 68 grade II-III-IV, and three deaths. In the multivariate models adjusted for center, the occurrence of complications was confirmed as a major independent factor associated with 3-year OS (HR 1.80; P = 0.008). Five-year OS was 25.6% (95%CI 14.9-37.6) for patients with complications and 45% (95%CI 33.3-53.4) for patients without.
  
  
  CONCLUSIONS
  Recent strategies facing advanced CLM include non-anatomic resections, portal-induced hypertrophy of the future remnant liver and aggressive medical preoperative treatments. CARe has the qualities of an approach that allows effective tumor clearance while maintaining good tolerance for the patient.
authors.affiliation: Digestive Tumours Unit, Institut Bergonié, Bordeaux, France; University of Bordeaux Segalen, Bordeaux, France.
authors.forename: Serge
authors.initials: S
authors.lastname: Evrard
authors.affiliation: Department of Hepatobiliary Surgery, North Western Hepatobiliary Centre, Aintree University Hospitals, Foundation Trust, Liverpool L9 7AL, United Kingdom.
authors.forename: Graeme
authors.initials: G
authors.lastname: Poston
authors.affiliation: Department of Surgery, Aarhus University Hospital, Århus C, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Kissmeyer-Nielsen
authors.affiliation: Clinical and Epidemiological Research Unit, Institut Bergonié, Bordeaux, France.
authors.forename: Abou
authors.initials: A
authors.lastname: Diallo
authors.affiliation: Digestive Tumours Unit, Institut Bergonié, Bordeaux, France.
authors.forename: Grégoire
authors.initials: G
authors.lastname: Desolneux
authors.affiliation: Clinical and Epidemiological Research Unit, Institut Bergonié, Bordeaux, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Brouste
authors.affiliation: Clinical and Epidemiological Research Unit, Institut Bergonié, Bordeaux, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Lalet
authors.affiliation: Department of Surgery, Aarhus University Hospital, Århus C, Denmark.
authors.forename: Frank
authors.initials: F
authors.lastname: Mortensen
authors.affiliation: Department of Hepatobiliary Surgery, North Western Hepatobiliary Centre, Aintree University Hospitals, Foundation Trust, Liverpool L9 7AL, United Kingdom; Department of General Surgery, HPB Unit, Paracelsus Private Medical University, Salzburg, Austria.
authors.forename: Stefan
authors.initials: S
authors.lastname: Stättner
authors.affiliation: Department of Hepatobiliary Surgery, North Western Hepatobiliary Centre, Aintree University Hospitals, Foundation Trust, Liverpool L9 7AL, United Kingdom.
authors.forename: Stephen
authors.initials: S
authors.lastname: Fenwick
authors.affiliation: Department of Hepatobiliary Surgery, North Western Hepatobiliary Centre, Aintree University Hospitals, Foundation Trust, Liverpool L9 7AL, United Kingdom.
authors.forename: Hassan
authors.initials: H
authors.lastname: Malik
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Konstantinidis
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America.
authors.forename: Ronald
authors.initials: R
authors.lastname: DeMatteo
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America.
authors.forename: Michael
authors.initials: M
authors.lastname: D'Angelica
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America.
authors.forename: Peter
authors.initials: P
authors.lastname: Allen
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America.
authors.forename: William
authors.initials: W
authors.lastname: Jarnagin
authors.affiliation: University of Bordeaux Segalen, Bordeaux, France; Clinical and Epidemiological Research Unit, Institut Bergonié, Bordeaux, France; INSERM ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Clinical Epidemiology and Clinical Investigation Centre CIC1401, Bordeaux, France.
authors.forename: Simone
authors.initials: S
authors.lastname: Mathoulin-Pelissier
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America.
authors.forename: Yuman
authors.initials: Y
authors.lastname: Fong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017115:Catheter Ablation / Q000009:adverse effects; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000473:pathology*; D003131:Combined Modality Therapy; D019468:Disease Management; D018450:Disease Progression; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D059351:Organ Sparing Treatments; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D047368:Tumor Burden