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From the Departments of Surgery (TMP, SAC) and Biostatistics (DSC, JSM), The University of Texas, M.D. Anderson Cancer Center, Houston, Texas; and the Department of Surgery (FI), The G. Pascale National Cancer Institute, Naples, Italy.
Correspondence: Address correspondence and reprint requests to: Steven A. Curley, MD, The University of Texas MD Anderson Cancer, Department of Surgical Oncology, Box 444, 1515 Holcombe Blvd, Houston, TX 77030; Fax: 713-745-5235; E-mail: scurley{at}mdanderson.org
Background: Resection combined with radiofrequency ablation (RFA) is a novel approach in patients who are otherwise unresectable. The objective of this study was to investigate the safety and efficacy of hepatic resection combined with RFA.
Methods: Patients with multifocal hepatic malignancies were treated with surgical resection combined with RFA. All patients were followed prospectively to assess complications, treatment response, and recurrence.
Results: Seven hundred thirty seven tumors in 172 patients were treated (124 with colorectal metastases; 48 with noncolorectal metastases). RFA was used to treat 350 tumors. Combined modality treatment was well tolerated with low operative times and minimal blood loss. The postoperative complication rate was 19.8% with a mortality rate of 2.3%. At a median follow-up of 21.3 months, tumors had recurred in 98 patients (56.9%). Failure at the RFA site was uncommon (2.3%). A combined total number of tumors treated with resection and RFA >10 was associated with a faster time to recurrence (P = .02). The median actuarial survival time was 45.5 months. Patients with noncolorectal metastases and those with less operative blood loss had an improved survival (P = .03 and P = .04, respectively), whereas radiofrequency ablating a lesion >3 cm adversely impacted survival (HR = 1.85, P = .04).
Conclusions: Resection combined with RFA provides a surgical option to a group of patients with liver metastases who traditionally are unresectable, and may increase long-term survival.
Key Words: Hepatocellular cancer • Liver metastases • Resection • Radiofrequency ablation
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