title: Optimizing treatment of hepatic metastases from colorectal cancer: Resection or resection plus ablation?
abstract: The present study determines the oncologic outcome of the combined resection and ablation strategy for colorectal liver metastases (CRLM). Between January 1994 and December 2014, 360 patients underwent surgery for CRLM. There were 280 patients who underwent hepatic resection only (group 1) and 80 hepatic resection plus ablation (group 2). group 2 patients had a higher incidence of multiple metastases than group 1 cases (100% in group 2 vs. 28.2% in group 1; P<0.001) and bilobar involvement (76.5% in group 2 vs. 12.9% in group 1; P<0.001). Perioperative mortality was nil in either group with a higher postoperative complication rate amongst group 1 vs. group 2 cases (18 vs. 0, respectively). The median follow-up was 90 months (range, 1-180) with a 5-year overall survival for group 1 and group 2 of 49 and 80%, respectively (P=0.193). The median disease-free survival for patients with R0 resection was 50, 43 and 34% at 1, 2 and 3 years, respectively, and remained steadily higher (at 50%) in those patients treated with resection combined with ablation up to 5 years (P=0.069). The only intraoperative ablation failure was for a large lesion (≥5 cm). Our data support the use of intraoperative ablation when complete hepatic resection cannot be achieved.
authors.affiliation: Unit of Innovative Techniques in Surgery, European Institute of Oncology, University of Milan, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Chiappa
authors.affiliation: Hepatobiliary Division, European Institute of Oncology, Milan, Italy.
authors.forename: Emilio
authors.initials: E
authors.lastname: Bertani
authors.affiliation: Department of General Surgery and Transplantation Chaim Sheba Medical Center, Sackler Medical School and Tel Aviv University, Tel Aviv, Israel.
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Zbar
authors.affiliation: Complex Unit of General Surgery, Surgical-Oncologic and Gastroenterologic Department of 'Luigi Sacco' Hospital, Milan University of Milan, Milan, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Foschi
authors.affiliation: Unit of Medical Oncology, European Institute of Oncology, Milan, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Fazio
authors.affiliation: Unit of Medical Oncology, European Institute of Oncology, Milan, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Zampino
authors.affiliation: General Oncologic Surgery, Oncologic Hospital, Aviano, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Belluco
authors.affiliation: Interventional Radiology Division, European Institute of Oncology, Milan, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Orsi
authors.affiliation: Interventional Radiology Division, European Institute of Oncology, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Della Vigna
authors.affiliation: Interventional Radiology Division, European Institute of Oncology, Milan, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Bonomo
authors.affiliation: Anaesthesiology Division, European Institute of Oncology, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Venturino
authors.affiliation: University of Milan, Milan, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Ferrari
authors.affiliation: Digestive Surgery, European Institute of Oncology, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Biffi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017115:Catheter Ablation / Q000379:methods; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy*; D003131:Combined Modality Therapy / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome