Clinical

Tumor ablation effective for bilateral colorectal liver metastases

Last Updated: 2013-05-16 16:04:09 -0400 (Reuters Health)

By Robert Saunders

NEW YORK (Reuters Health) - Ablation of bilateral liver metastases from colorectal cancer, with or without surgery, compares well to the gold standard approach of bilateral resection, according to a report from Memorial Sloan-Kettering Cancer Center in New York City.

"Patients treated with ablation, either alone or in combination with resection, had less intraoperative blood loss, similar perioperative mortality, shorter length of hospitalization, and similar overall 5-year survival," the researchers found.

"Ablation techniques for tumor are a safe tool for the killing of cancer," lead investigator Dr. Yuman Fong commented in an email to Reuters Health. "Ablation combined with traditional removal of tumor allows many more patients to be treated for potential cure."

In a paper online May 8th in JAMA Surgery, Dr. Fong and colleagues refer to a "compelling need" to further define the usefulness of ablation in patients with colorectal liver metastases.

The team used the Sloan-Kettering database to study 95 patients with bilateral colorectal liver metastases who were treated with radiofrequency or microwave ablation with or without resection between 2004 and 2008, plus 141 patients who had conventional bilateral resection before 2004, i.e. prior to the introduction of ablation. They used nonsimultaneous cohorts in order to minimize patient selection bias inherent in more recent data.

While median operative times were similar in both groups, other perioperative outcomes favored the ablation group, which had less blood loss on average (300 vs 500 mL; p<0.01) and a shorter mean hospital stay (7 vs 9 days; p<0.01).

And while the ablation cohort had a poorer Clinical Risk Score, five-year overall survival in the two groups was similar, at 56% with ablation vs 49% with bilateral resection (p=0.16).

Summing up, Dr. Fong and colleagues concluded, "Treatment of bilateral, multiple hepatic metastases with combined resection and ablation was associated with improved perioperative outcomes without compromising long-term survival compared with bilateral resection."

Ideally, they said, the two strategies should be compared in a randomized trial, but that would be difficult because of the "intuitive" selection of patients for ablation or resection. "In general," they wrote, "patients with multiple tumors confined to one region of the liver or with large solitary metastases should undergo resection. Ablation in these settings would be, at best, inefficient and, at worst, ineffective. In contrast, ablation may play a role for patients with a limited number of small metastases deep within the hepatic parenchyma."

Meanwhile, Dr. Fong added in his email, "We are in the process of combining our data with data from France, Great Britain, and Belgium to see if findings are the same in other countries and in treatment of patients with other ethnicity. That data will be presented at the ASCO meeting in June."

SOURCE: http://bit.ly/148tvkH

JAMA Surg 2013.