Combined Resection And Radiofrequency Ablation For Bilobar Liver Metastases

Abstract

Introduction: Surgical resection remains the only potential curative treatment for colorectal cancer liver metastases (CRCLM). Bilobar disease was traditionally considered unresectable. Novel techniques such as radiofrequency-ablation (RFA) have been employed as an adjunct to traditional hepatic resection, however few have reported outcomes using this approach. The present study's aim is to report our experience of hepatic resection combined with intra-operative RFA in patients with initially unresectable bilobar CRCLM compared with patients who underwent simple resection of unilobar metastases. Patients: 95 patients underwent resection for CRCLM between 2000-2007. Of these 16 patients had additional RFA for bilobar disease at the time of resection. The majority of the total population were > 75 years (83%), male (57%), had metachronous disease (64%) and a single liver metastasis (57%). Those who had additional RFA had a median number of liver metastases of 3 (2-7). Results: Median follow-up of the survivors was 26.7 months (24.4 months for RFA plus resection and 31.4 months for resection alone); during which 48 died, 44 from recurrent cancer. Median hospital stay was 11 days for both groups. 30-day morbidity rate was 25% for each group. There was no peri-operative mortality. Acturial 3-year survival rates were 50% for liver resection alone and 54% for RFA plus resection. One patient who underwent RFA plus resection is alive at 57 months. Conclusions: In our experience those who undergo RFA plus resection for bilobar liver metastases can achieve perioperative and survival outcomes comparable to patients who have resection alone for unilobar metastases.