Ablation adds value to the surgical treatment of colorectal liver metastases

Aims: To evaluate the role of radiofrequency ablation (RFA) in patients with synchronous (S) and metachronous (M) colorectal liver metastases (CRC-LM) Methods: In a period of 5 years 149 patients with CRCLM (97S, 52M) were retrospectively analyzed: 120 patients underwent surgical treatment (70 S, 50 M), 29 chemotherapy alone (27 S, 2 M). Surgical treatment consisted in Hepatic Resection (HR) 78/120, RFA 33/120 and combined approach (CA) 9/120. The OS e DFS between HR and RFA groups were evaluated. The two groups were similar in terms of age (median 63,8 y, 22–86), LM size (median 30 mm, 7–100), LM site (right lobe 38HR vs 25RFA), extrahepatic liver disease(7HRvs1RFA) and neoadjuvant chemotherapy(9HR vs 5RFA). The variables analyzed were age, LM size, LM site, primary surgical treatment (colon-liver), single LM. Data were analyzed with life tables and log rank test Results: The 5y-OS and DFS were respectively 47% and 20% for RFA vs 38% and 42% for HR (p n.s.). There were no differences in OS and DFS in terms of age(≥ 65 y), site of LM (right lobe), primary surgical treatment (colon-liver), single LM. For LM sized <25mm OS was 24% for HR vs 42% for RFA (p n.s.) and DFS 41% for HR vs 51,3 for RFA (p n.s.) but for sized ≥ 25mm DFS was for HR and RFA respectively 44,1% and 7,8% (p 0.056). 67/120 patients (55,8%) presented hepatic recurrence (40/78 HR, 19/33 RFA) and 37/59 underwent repeated surgical treatments (11HR, 18RFA, 2 CA, 6 not treated) Conclusions: RFA may be a valid alternative treatment for CRCLM, especially, in patients with LM sized <25 mm and an adjunctive treatment, in combined approach, to avoid major hepatectomy and to treat recurrence with repeated and sequential treatments.