Long-term outcomes of radiofrequency ablation combined with hepatectomy compared with hepatectomy alone for colorectal liver metastases

Imai, Katsunori; Allard, M.-A.; Benítez, Carlos Castro; Vibert, Éric; Cunha, Antonio Sa; Cherqui, Daniel; Castaing, Denis; Baba, Hideo; Adam, René

doi:10.1002/bjs.10447

Cited by 82 publications

(62 citation statements)

References 33 publications

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“…4). Fourteen studies compared RFA with surgery alone [13, 30–42], eight studies compared RFA + PH with PH alone [13, 15, 16, 18, 27, 28, 43, 44], and four studies compared RFA to RFA + PH or PH alone [13, 45–47]. A total number of 5020 patients were included in these observational studies (RFA: N = 1103; RFA + PH: N = 541; PH alone: N = 3376).…”

Section: Resultsmentioning

confidence: 99%

“…6) [13, 15, 16, 18, 27, 45, 46]. No significant difference in OS was found (HR = 1.24; 95%CI 0.84–1.84).…”

Section: Resultsmentioning

confidence: 99%

“…Of the observational studies comparing RFA + PH and PH alone, one study ( N = 113) reported 30-day mortality [39], two studies ( N = 232) reported 60-day mortality [18, 44] (Fig. 8) and two studies ( N = 709) reported 90-day mortality [15, 27] (Fig. 9).…”

Section: Resultsmentioning

confidence: 99%

“…Of the observational studies comparing RFA + PH and PH alone, Faitot et al reported serious adverse events in 28% after PH (≥ grade 3) versus 13% in the combination group ( p = 0.017) [15]. Imai et al reported major complications in 18.6% in the PH alone group (≥ grade 3) versus 22% after PF + RFA ( p = 0.656) [27]. Kim et al reported adverse events in 21% after PH (278 patients: 13 haemorrhage, 17 abscesses, 10 wound infections, 8 respiratory failure, 11 ileus) versus 37% in the combination group (27 patients: 3 haemorrhage, 3 abscess, 3 wound infection, 1 respiratory failure) ( p < 0.001) [47].…”

Section: Resultsmentioning

confidence: 99%

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Radiofrequency and Microwave Ablation Compared to Systemic Chemotherapy and to Partial Hepatectomy in the Treatment of Colorectal Liver Metastases: A Systematic Review and Meta-Analysis

Meijerink

Puijk

Tilborg

et al. 2018

Cardiovasc Intervent Radiol

165

131

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PurposeTo assess safety and outcome of radiofrequency ablation (RFA) and microwave ablation (MWA) as compared to systemic chemotherapy and partial hepatectomy (PH) in the treatment of colorectal liver metastases (CRLM).MethodsMEDLINE, Embase and the Cochrane Library were searched. Randomized trials and comparative observational studies with multivariate analysis and/or matching were included. Guidelines from National Guideline Clearinghouse and Guidelines International Network were assessed using the AGREE II instrument.ResultsThe search revealed 3530 records; 328 were selected for full-text review; 48 were included: 8 systematic reviews, 2 randomized studies, 26 comparative observational studies, 2 guideline-articles and 10 case series; in addition 13 guidelines were evaluated. Literature to assess the effectiveness of ablation was limited. RFA + systemic chemotherapy was superior to chemotherapy alone. PH was superior to RFA alone but not to RFA + PH or to MWA. Compared to PH, RFA showed fewer complications, MWA did not. Outcomes were subject to residual confounding since ablation was only employed for unresectable disease.ConclusionThe results from the EORTC-CLOCC trial, the comparable survival for ablation + PH versus PH alone, the potential to induce long-term disease control and the low complication rate argue in favour of ablation over chemotherapy alone. Further randomized comparisons of ablation to current-day chemotherapy alone should therefore be considered unethical. Hence, the highest achievable level of evidence for unresectable CRLM seems reached. The apparent selection bias from previous studies and the superior safety profile mandate the setup of randomized controlled trials comparing ablation to surgery.Electronic supplementary materialThe online version of this article (10.1007/s00270-018-1959-3) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

“…6) [13, 15, 16, 18, 27, 45, 46]. No significant difference in OS was found (HR = 1.24; 95%CI 0.84–1.84).…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Radiofrequency and Microwave Ablation Compared to Systemic Chemotherapy and to Partial Hepatectomy in the Treatment of Colorectal Liver Metastases: A Systematic Review and Meta-Analysis

Meijerink

Puijk

Tilborg

et al. 2018

Cardiovasc Intervent Radiol

165

131

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“…Among these, RFA is the most used, most of the studies showing a recurrence rate similar to hepatic resection when used for less than 3 cm CLMs (129). The advantages of combined liver resection and ablation are the avoidance of major hepatic resections, preserving an important non-tumoral hepatic parenchyma (130,131). A pitfall in using this approach concerns the fact that patients with CLMs larger than 3 cm or without complete ablation of CLMs cannot obtain similar long-term outcome.…”

Section: E Combined Ablation and Liver Resection (Care)mentioning

confidence: 99%

Surgical Options in Synchronous Liver Metastases from Colorectal Cancer

Alexandrescu¹,

Diaconescu²,

Popescu³

2017

JTMR

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Currently, the treatment of liver metastases of colorectal cancer (CRC) requires a multidisciplinary approach and should be individualized for each patient. Liver resection provides 5 years survival rates ranging between 30 and 58% in patients with liver metastases of CRC. The optimal timing of liver resection, resection of the primary tumor and neoadjuvant chemotherapy has not been fully established, yet, neither for initially resectable synchronous liver metastases, nor for those initially unresectable which could be converted to resectability. Advocates of simultaneous resection and those of staged resection (delayed liver resection or "liver first approach"), both presented theoretical arguments in favor of each of these therapeutic strategies. Progresses in liver surgery, anesthesia, intensive care and oncology caused a paradigm shift regarding the approach of synchronous colorectal liver metastases, with simultaneous resection (SR) becoming a safer procedure in the last decade. As well, the oncologic outcomes of SR are similar to those achieved by staged resection. In this review we present the literature data concerning the results achieved by each of the currently available therapeutic approaches. Abbreviations: CLMs -colorectal liver metastases, SCLMs -synchronous colorectal liver metastases, CRC -colorectal cancer, PVL-portal vein ligation, PVE -portal vein embolization, SR -simultaneous resection, DR -delayed liver resection, SgR -staged resections, FLR -future liver remnant, CHT -chemotherapy, OS -overall survival, DFS -disease-free survival, ETS -early tumor shrinkage

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Management of Metastic Liver Cancer

Stewart,

Ho,

Fong

et al. 2024

Gastrointestinal Oncology ‐ a Critical Multidisciplinary Team Approach 2e

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Long-term outcomes of radiofrequency ablation combined with hepatectomy compared with hepatectomy alone for colorectal liver metastases

Abstract: Hepatectomy + RFA achieved outcomes comparable to hepatectomy alone. Combining RFA with hepatectomy should be considered as an option to achieve cure.

Cited by 82 publications

References 33 publications

Radiofrequency and Microwave Ablation Compared to Systemic Chemotherapy and to Partial Hepatectomy in the Treatment of Colorectal Liver Metastases: A Systematic Review and Meta-Analysis

Radiofrequency and Microwave Ablation Compared to Systemic Chemotherapy and to Partial Hepatectomy in the Treatment of Colorectal Liver Metastases: A Systematic Review and Meta-Analysis

Surgical Options in Synchronous Liver Metastases from Colorectal Cancer

Management of Metastic Liver Cancer

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