Radiofrequency Ablation vs. Resection for Hepatic Colorectal Metastasis: Therapeutically Equivalent?

Reuter, Nathaniel P.; Woodall, Charles E.; Scoggins, Charles R.; McMasters, Kelly M.; Martin, Robert C.G.

doi:10.1007/s11605-008-0727-0

Cited by 114 publications

(60 citation statements)

References 18 publications

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“…The role of targeted therapies in neoadjuvant setting of potentially resectable CLM remains to be defined and needs further studies. Finally, where a local approach to CLM is indicated and surgery is contraindicated, the radiofrequency ablation of liver metastases is often considered a good alternative, although generally less effective than surgery in terms of relapse rate and OS [70][71][72][73][74][75][76] . (Table 2).…”

Section: Resultsmentioning

confidence: 99%

Management of potentially resectable colorectal cancer liver metastases

Meriggi

Bertocchi²,

Zaniboni³

2013

WJGS

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Colorectal cancer is a very common malignancy worldwide and development of liver metastases, both synchronous or metachronous, is a common event. Of all patients with metastatic colorectal cancer, up to 77% have a liver-only disease and approximately 10%-20% of patients with colorectal liver metastases are considered resectable at the time of diagnosis. Surgical resection of liver metastases remains the best treatment option and it is associated with a survival plateau and a 20%-25% of long-term survivors. Perioperative chemotherapy for resectable liver metastases may improve resecability of liver metastases and disease free survival, but its impact on overall survival is still unclear and more studies are needed. Moreover, preoperative chemotherapy can increase postoperative complications. Further studies are needed to define the role of adjuvant chemotherapy after a R0 resection of liver metastases and to define the criteria for a better selection of patients candidate to hepatectomy. New strategies such as targeted therapies are emerging with promising results. Optimal management requires a multidisciplinary approach, local and systemic, but it is a still pending question. Colorectal liver metastases represent a major challenge for oncologists and surgeons. In this review will be analyzed available data about assessment and management of the patients with potentially resectable colorectal liver metastases.© 2013 Baishideng. All rights reserved. Key words: Colorectal cancer; Liver metastases; Perioperative chemotherapy; Surgical resection; Targeted therapiesCore tip: Colorectal cancer is a very common malignancy and its incidence is rapidly increasing worldwide. Of all patients with metastatic colorectal cancer, up to 77% have a liver-only disease and about 10%-20% of them are considered resectable at the time of diagnosis. Surgery actually still represents the best option of treatment, but new strategies such as perioperative chemotherapy and targeted therapies are emerging with promising results. However, optimal management requires a multidisciplinary approach, both local and systemic. This review aims to critically analyze the management of potentially resectable colorectal liver metastases.Meriggi F, Bertocchi P, Zaniboni A. Management of potentially resectable colorectal cancer liver metastases. World J Gastrointest Surg 2013; 5(5): 138-145 Available from:

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Section: Resultsmentioning

confidence: 99%

Management of potentially resectable colorectal cancer liver metastases

Meriggi

Bertocchi²,

Zaniboni³

2013

WJGS

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“…Currently, complete neoplasm resection is regarded as the only curative therapeutic option for those patients [20] . Despite broadening resectability criteria in recent years, only a selected group (20%-30%) will be candidates for curative resection [21] .…”

Section: Discussionmentioning

confidence: 99%

Patients with multiple synchronous colonic cancer hepatic metastases benefit from enrolment in a “liver first” approach protocol

Kardassis¹

2014

WJH

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AIM:To assess a protocol for treating patients with multiple synchronous colonic cancer liver metastases, which are unresectable in one stage. METHODS:Patients enrolled in the "liver first" protocol presented with colon-only (not rectal) cancer and multiple synchronous hepatic metastases (type Ⅱ or Ⅲ). All patients showed good performance status (ECOG PS 0-1) and were treated with curative intent. Complete oncologic staging including positron emission tomography-computed tomography was performed in order to rule out extrahepatic disease. If bowel obstruction was imminent, an intraluminal colonic stent was placed endoscopically. Subsequently, all patients received standardised neo-adjuvant chemotherapy, that is, FOLFOX or XELOX regimens combined with an antiangiogenic agent (bevacizumab or cetuximab). Provided that a response to chemotherapy was observed, patients underwent either one or two hepatectomies with or without portal vein embolization followed by the indicated colectomy. Further chemotherapy was administered after each procedure. Re-staging was performed after each chemotherapeutic treatment. Disease progression at any stage resulted in discontinuation of the protocol and conversion to palliative disease management. RESULTS:Prospectively recorded data from 11 consecutive patients (8 men) were analysed for this study. Their mean age at the time of their first assessment was 65.7 (SD ± 15.3) years. Six (54.6%) patients presented with type Ⅲ metastatic disease. The minimum and maximum follow-up periods were 7.3 and 39.6 mo, respectively. The mean overall survival of all patients was 16.5 (95%CI: 10.0-23.2) mo. A colonic stent had to be placed in 5 (45.5%) patients due to the onset of an intraluminal obstruction. Four (36.4%) patients succeeded in completing all planned surgical operations. Their mean overall survival was 27.2 (95%CI: 15.1-39.3) mo and the mean disease-free survival was 7.7 (95%CI: 3.0-12.5) mo. Patients, who were obliged to shift to palliative treatment due to disease progression, had a mean overall survival of 10.5 (95%CI: 8.6-12.4) mo. None of these patients underwent palliative colectomy. No postoperative mortality was recorded. CONCLUSION:The implementation of a structured "liver first" approach protocol for the treatment of pa- Patients with multiple synchronous colonic cancer hepatic metastases benefit from enrolment in a "liver first" approach protocol tients with extensive, liver-limited colon cancer metastatic disease may be beneficial. CLINICAL TRIALS STUDY

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“…Thus, RFA patients were more likely to recur near the RFA site due to incomplete ablation of lesion size, heat sink effect, or limitations of the technique. On the other hand, removing the hepatic parenchyma proved to be more clinically effective [52]. Sanghwa Ko et al [53] presented as well a retrospective study of 29 patients suggesting that RFA is significantly inferior to surgical resection in patients with tumor size higher than 3 cm.…”

Section: Rfa Vs Liver Resectionmentioning

confidence: 99%

Surgical hepatic resection vs. ultrasonographic guided radiofrequency ablation in colorectal liver metastases: what should we choose?

et al. 2014

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Clinical evolution of the colorectal carcinoma occurs in up to 60% with colorectal liver metastases (CRLM). Although hepatic resection is considered to be the golden standard in CRLM, novel less invasive techniques have emerged, of which radiofrequency ablation has received a high credibility. When tumors are not eligible for surgery, guided radiofrequency ablation is considered an alternative. This method is appropriate when there are no more than 5 lesions with a diameter of less than 3 cm. While open surgery guarantees a more precise tumor excision, the effectiveness of ablation must be evaluated either by contrast-enhanced computer tomography, magnetic resonance, or ultrasound. This paper aims to review the current standings in radiofrequency ablation for CRLM and to compare the technique with surgical resection in order to find which one is the best treatment option.

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Radiofrequency Ablation vs. Resection for Hepatic Colorectal Metastasis: Therapeutically Equivalent?

Abstract: Surgical resection is associated with a lower chance of recurrence and a longer disease-free interval than RFA and should remain the treatment of choice in resectable HCM.

Cited by 114 publications

References 18 publications

Management of potentially resectable colorectal cancer liver metastases

Management of potentially resectable colorectal cancer liver metastases

Patients with multiple synchronous colonic cancer hepatic metastases benefit from enrolment in a “liver first” approach protocol

Surgical hepatic resection vs. ultrasonographic guided radiofrequency ablation in colorectal liver metastases: what should we choose?

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