Prolonged survival after radiofrequency ablation of synchronous colorectal liver metastases

Abstract

3763 Background: Synchronous liver metastasis (SLM), commonly defined as liver metastasis occurring within 12 months of the colon primary, represents 13–25% of the 90,000 newly diagnosed colorectal liver metastases. SLM have historically been found to have a worse overall survival when compared to metachronous lesions. The primary reason for this worse overall survival has been related to a majority of patients having unresectable disease because of multiple bilobar tumors or comorbid conditions. We hypothesized that patients with synchronous liver metastases would benefit from an aggressive ablation and resection to the same degree as patients with metachronous metastases. Methods: Review of our prospective database revealed 64 pts with unresectable colorectal liver metastases treated since 1998. The vast majority of patients underwent RFA as an open procedure. Survival was determined by the Kaplan-Meier. Results: Sixty-four pts underwent treatment for 200 liver metastases (38 resected, 162 RFA; mean 3.1 tumors/pt). Median age was 63 years (range 17–88). Median follow-up was 22 mo. The median size of the largest metastasis was 3 cm (range 1–10 cm). RFA was performed for 9 pts known to have minimal extrahepatic (EH) disease preoperatively, and 6 who were found to have EH disease at operation. Synchronous metastases were present in 38 pts. Eighteen pts (28%) experienced postoperative complications, usually minor and self-limited. Thirty-day mortality was 1.6%. Repeat RFA was performed in 11 pts for liver recurrence. Median disease-free and overall survival rates for the entire group were 12 and 31 mo, respectively. Median overall survival rates were 26 and 36 mo, respectively, for pts with or without EH metastasis (P=0.14). There were no differences in survival for pts with synchronous vs. metachronous liver metastases, or for pts who underwent RFA alone vs. RFA + resection. Conclusions: RFA is as effective for patients with synchronous metastases as it is for those with metachronous metastases. Patients without EH disease appear to benefit the most, although further study is necessary to determine the potential benefit for patients with limited EH disease. No significant financial relationships to disclose.