Long-term outcome for colorectal liver metastases: combining hepatectomy with intraoperative ultrasound guided open microwave ablation versus hepatectomy alone

Abstract

Objective: To compare the long-term outcome of combining hepatectomy with intraoperative ultrasound (IOUS)-guided open microwave ablation (MWA) versus hepatectomy alone in patients with colorectal cancer liver metastases (CRLM). Method: A retrospective analysis of patients with CRLM who underwent hepatectomy alone (HT group; 380 patients) or hepatectomy combined with IOUS-guided open MWA (HT þ MWA group; 57 patients) from April 2002 to September 2018 was conducted at our center. A propensity scorematched (PSM) analysis was used to reduce data bias between the two groups. Results: The overall survival (OS) and disease-free survival (DFS) were not significantly different between the two groups after matching. Although intrahepatic recurrence was more frequent in the HT þ MWA group in both the whole and matched cohort, the two groups exhibited similar rates of extrahepatic recurrence as well as concomitant intra-and extrahepatic recurrence. A higher number of CRLM (>3), larger maximum-size and absence of response to induction chemotherapy were independent risk factors for OS. Conclusion: The oncological outcomes of hepatectomy combined with intraoperative open ablation was not significantly different to hepatectomy alone and should be considered as a safe and fair option for patients with difficultly resectable CRLM.

Trends and overall survival after combined liver resection and thermal ablation of colorectal liver metastases: a nationwide population-based propensity score-matched study

“…Results of the current study were concordant with some smaller matched cohort studies. [27][28][29][30][31][32] In the matched cohort, no significant differences in overall morbidity, major morbidity and lower 30-day mortality were observed in patients treated with liver resection compared to combined resection and ablation. Several other reports described at least similar mortality and morbidity rates after combined therapy compared to surgery alone.…”

“…Several other reports described at least similar mortality and morbidity rates after combined therapy compared to surgery alone. 2,3,28,[30][31][32] This indicates that combined resection and ablation seems a safe treatment option.…”

“…Previous matched studies on combined liver resection and ablation reported similar disease-free survival rates. [30][31][32] Contrasting results on local recurrence in the liver have been reported, with a disadvantage for patients treated with combined resection and ablation. 31,32 However, a recent retrospective study found a weak correlation between overall and recurrence-free survival and the development of recurrent CRLM after liver resection does not necessarily preclude curability.…”

“…[30][31][32] Contrasting results on local recurrence in the liver have been reported, with a disadvantage for patients treated with combined resection and ablation. 31,32 However, a recent retrospective study found a weak correlation between overall and recurrence-free survival and the development of recurrent CRLM after liver resection does not necessarily preclude curability. 33 When feasible, repeat local treatment of recurrent disease shows similar survival to those after first liver resection.…”

The use of ultrasound in colonic and perianal diseases

“…radiofrequency or microwave ablation [MWA] – performed percutaneously, or with IOUS-guidance during open surgery) alone or besides hepatectomy. IOUS-guided open MWA combined with hepatectomy has similar oncological outcomes as hepatectomy alone [ 36 ▪ ], and US-guided percutaneous MWA has similar overall long-term survival rates, fewer complications and shorter hospital stay, yet worse local tumor progression free survival rates than CRLM resection[ 37 ▪ ]. A risk classification system has also been developed to facilitate personalized assessment of intrahepatic progression free survival for patients receiving US-guided percutaneous MWA for CRLM [ 38 ▪▪ ].…”