Curative-intent treatment of recurrent colorectal liver metastases: A comparison between ablation and resection.

Abstract

BACKGROUND:

Liver-limited recurrence after resection of colorectal liver metastases is a frequent occurrence, and can in some cases be treated with curative intent. Although surgical re-resection remains standard of care, there is growing interest in the role of ablation in this setting. The aim of this study was to compare the outcomes after curative-intent ablation and resection in patients with recurrent colorectal liver metastases.

METHODS:

We retrospectively analysed data from 366 consecutive patients who underwent liver resection for colorectal liver metastases between June 2010 and August 2015. Sixty-four developed liver-limited recurrence which was treated with curative intent, thirty-three (51.6%) by ablation and 31 (48.4%) by repeat resection.

RESULTS:

Patient groups were well matched, with surgically resected patients showing higher pre-operative carcinoembryonic antigen levels and larger metastases. There were fewer post-operative complications and shorter length of stay in the ablation group (p < 0.02). After a median follow-up of 36.2 months, median overall survival was the same for both the resected and ablated groups at 33.3 months. Median progression-free survival was longer for patients treated with surgery (10.2 months) compared to ablation (4.3 months) (p = 0.002).

CONCLUSIONS:

Ablation or resection for liver-limited recurrence after surgery for colorectal liver metastases is associated with improved overall survival compared with systemic chemotherapy alone, and should always be considered for patients with resectable liver recurrence. Although ablation seemed to be associated with a shorter progression-free survival, post-procedure morbidity was significantly lower. The choice between ablation and resection should therefore be made on a personalised basis.

• Authors: Aurélien Dupré, Robert P Jones, Rafael Diaz-Nieto, Stephen W Fenwick, Graeme J Poston, Hassan Z Malik
• Journal: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology (Eur J Surg Oncol) Vol. 43 Issue 10 Pg. 1901-1907 (Oct 2017) ISSN: 1532-2157 [Electronic] England
• PMID: 28888801 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

Topics

• Ablation Techniques (methods)
• Adult
• Aged
• Aged, 80 and over
• Colorectal Neoplasms (mortality, pathology)
• Female
• Follow-Up Studies
• Hepatectomy (methods)
• Humans
• Incidence
• Liver Neoplasms (diagnosis, secondary, surgery)
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Neoplasm Metastasis
• Neoplasm Recurrence, Local (epidemiology)
• Prognosis
• Retrospective Studies
• Survival Rate (trends)
• Time Factors
• Tomography, X-Ray Computed
• United Kingdom (epidemiology)