Abstract
Background: Successful use of ablation for small hepatocellular carcinomas (HCC) has led to interest in the role of ablation for colorectal liver metastases (CRLM). However, there remains a lack of clarity about the use of ablation for colorectal liver metastases (CRLM), specifically its efficacy compared with hepatic resection.Methods: A systematic review of the literature on ablation or resection of colorectal liver metastases was performed using MEDLINE, Cochrane Library, and Embase until December 2018. The aim of this study was to summarize the evidence for ablation vs. resection in the treatment of CRLM.Results: This review identified 1,773 studies of which 18 were eligible for inclusion. In the majority of the studies, overall survival (OS) and disease-free survival (DFS) were significantly higher and local recurrence (LR) rates were significantly lower in the resection groups. On subgroup analysis of solitary CRLM, resection was associated with improved OS, DFS, and reduced LR. Three series assessed the outcome of resection vs. ablation for technically resectable CRLM, and showed improved outcome in the resection group. In fact, there were no studies showing a survival advantage of ablation compared to resection in the treatment of CRLM.Conclusions: Resection remains the “gold standard” in the treatment of CRLM and should not be replaced by ablation at present. This review supports the use of ablation only as an adjunct to resection and as a single treatment option when resection is not safely possible.
Highlights
IntroductionAt the time of diagnosis, 30–50% of the patients already have (synchronous) or will develop (metachronous) colorectal liver metastases (CRLM) in the further course of their disease [2]
RationaleColorectal cancer (CRC) is the third most common cancer worldwide [1]
We found that the groups compared in the different studies were inhomogeneous in terms of patient characteristics
Summary
At the time of diagnosis, 30–50% of the patients already have (synchronous) or will develop (metachronous) colorectal liver metastases (CRLM) in the further course of their disease [2]. In metastatic CRC limited to the liver without extrahepatic disease, resection of liver lesions remains the gold standard with 5 year survivals reported to be over 60% for selected patients [3, 4]. Richard Cattel performed the first resection of colorectal liver metastases in 1940. It took several decades for the impact of liver surgery on overall survival (OS) and disease free survival (DFS) to be recognized [5]. There remains a lack of clarity about the use of ablation for colorectal liver metastases (CRLM), its efficacy compared with hepatic resection
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