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Role of intraoperative thermoablation combined with resection in the treatment of hepatic metastasis from colorectal cancer.

HYPOTHESIS
Thermoablation, either cryosurgical ablation (CSA) or radiofrequency ablation (RFA), combined with resection is effective in the treatment of extensive bilobar colorectal metastasis.


DESIGN
Retrospective analysis of a prospective hepatobiliary surgical database.


SETTING
Tertiary care referral center.


PATIENTS
Consecutive patients with colorectal hepatic metastases selected for surgical treatment.


INTERVENTIONS
All patients underwent hepatic resection combined with CSA or RFA.


MAIN OUTCOME MEASURES
Local recurrence rates at ablation sites, overall survival, disease-free survival, and hepatic disease-free survival.


RESULTS
Between January 1, 1998, and December 31, 2003, 665 patients with colorectal metastases underwent hepatic resection. Of these, 39 (5.9%) had additional intraoperative thermoablative procedures (19 RFA, 20 CSA). There was 1 (3%) postoperative death not directly associated with the ablation, and the total morbidity rate was 41% (16 of 39). No RFA-related complication occurred; however, 3 patients developed an abscess at cryoablation sites. Actuarial 3-year survival was 47% for the entire group, with a median follow-up of 21.1 months (range, 0.5-71.4 months). The median disease-free survival was 12.3 months (range, 8.4-16.2 months). Overall, the local in situ recurrence rate according to number of ablated tumors was 14% for RFA and 12% for CSA. Tumor size correlated directly with recurrence (P = .02) in RFA-treated lesions.


CONCLUSIONS
Ablation combined with hepatic resection is rarely necessary or applicable. However, in selected patients whose tumors were otherwise unresectable, additional use of ablation allows effective clearance of disease. In these patients with extensive bilobar disease, recurrence rates are high, but long-term survival is encouraging and may be improved with aggressive postoperative chemotherapy.