5-Year Survival Following Radiofrequency Ablation of Colorectal Liver Mestastases: A 10-Year Experience
Tayyab S. Diwan, M.D., Maria A. Cassera, B.S., Peter M. Denk, M.D., Yashodhan S. Khajanchee, M.D., Charlynn Wilson, R.N., Michael B. Ujiki, M.D., Lee L. Swanström, M.D., and Paul Hansen, M.D.
Purpose
Radiofrequency ablation (RFA) of colorectal liver mestastases (CRLM) is a relatively new technique which may provide local control of tumors while causing minimal impact on the patient’s health and quality of life. There is little data on long-term outcomes and patient survival following RFA. The purpose of this study was to review our 10-year experience with patients undergoing RFA and CRLM with a focus on technique, patient selection and 5-year survival.
Methods
Data was collected prospectively on 119 consecutive patients who underwent RFA of isolated CRLM at a single institution between September 1996 and June 2006.
Results
Of the 119 patients, 137 procedures were performed, 117 (85%) were performed laparoscopically, 1 trans-diaphragmatic thoracoscopically, 11 performed via laparotomy, and 8 percutaneously. The average ASA of patients was 3.03. Fifty-two percent of patients had significant preoperative cardiopulmonary co-morbidities. Two hundred and seventy-seven tumors were ablated (mean 2.24 [SD ± 1.56] tumors per patient). The average maximal tumor diameter was 2.6cm (SD ± 1.55). The overall complication rate was 11.7 % (14/119) including one death (0.8%). RFA site failures occurred in 14/277 (5%) per tumor or 14/119 (11.7 %) per patient. At an average follow-up of 30.2 months, the 5-year disease-free survival was 33.8%, and 5-year overall survival was 37.3%.
Conclusion
This review demonstrates long-term survivorship using RFA to treat CRLM in a high-risk group of patients. As more long-term follow-up data becomes available, the appropriate role of RFA in the management of CRLM will evolve. We expect future studies will report even better survival outcomes as the current data represents our learning curve, the evolution of RFA devices, and the use of this technique primarily for high-risk patients. We believe that with experience, CRLM less than 3cm in diameter and more than 2cm from the central bile ducts may be definitively treated with laparoscopic RFA.
For more information, phansen@orclinic.com.