Comparison of results of radiofrequency ablation and resection in the treatment of liver metastases of colorectal cancer
Abstract
ntroduction: 60% of patients with colorectal cancer (CRC) are diagnosed with liver metastases. The average survival time of Stage IV CRC patients does not exceed 3 years.
Surgical treatment remains the only potentially curable method with a 5-year survival exceeding 50%. Radiofrequency ablation (RFA) is an integral part of the comprehensive treatment of patients with hepatic CRC metastases.
RFA uses 500-1,000 kHz AC voltage between the needle tip and the body electrode on the body. Sufficient current densities required for tissue destruction are achieved only at the catheter tip where thermal coagulation necrosis occurs.
RFA is controlled by either impedance (CoolTip) or temperature (RITA), the duration is usually 5-12 minutes. It was first used more than 20 years ago for HCC.
There are two basic methods - percutaneous (CT, ultrasound) and peroperative (laparoscopic or laparotomy). The aim of the paper is to present our experience with this method.
Material and methods: In 2013-2016, we included 334 patients with hepatic CRC metastases within the IGA NT-13660 project; In all patients we monitored postoperative morbidity, overall survival and quality of life. We compared the obtained results with resected patients.
We used Fisher's exact test and chi-square test as appropriate for statistical processing. Results: Out of 56 patients treated with RFA, CT navigated RFA was used in 26.8%, laparotomy in 73.2%.
Combined resection and RFA were performed in 64.2% of patients, only RFA in 35.8% of patients. In liver metastasis recurrence surgery, RFA was the most common modality (43.2%); 5-year survival was lower in the RFA group (32 vs. 43%, p = 0.052).
Morbidity was significantly lower in the RFA group (Clavien-Dindo> 2, 18 vs. 24%). There was no difference in the quality of life assessment according to the EORTC (European Organization for Research and Treatment of Cancer) questionnaires.
Conclusion: Our results show that RFA shows lower postoperative morbidity, but higher local recurrence and lower overall survival compared to resection therapy. The results are on the edge of statistical significance.
Indications for RFA significantly increase in procedures for recurrence of liver CRC metastases. Randomized studies are missing.
Strict adherence to a multidisciplinary approach is necessary, taking into account the individuality of the individual patient.