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Radiofrequency Ablation Versus Resection for Resectable Colorectal Liver Metastases: Time for a Randomized Trial?

¹ Department of Surgery, Leopold Park Clinic, Froissartstraat 34, B-1040 Brussels, Belgium
² Department of Radiology, University Hospital Gasthuisberg, Catholic University of Leuven, Herestraat 49, B-3000 Leuven, Belgium
³ Department of Biostatistics, University Hospital of Mont-Godinne, Catholic University of Louvain, Avenue du Dr. Thérasse 1, B-5530 Yvoir, Belgium
⁴ Department of Surgery, University Hospital of Mont-Godinne, Catholic University of Louvain, Avenue du Dr. Thérasse 1, B-5530 Yvoir, Belgium
⁵ Department of Surgery, Antoni van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Postbus 90203, 1006 BE Amsterdam, The Netherlands

Correspondence: Address correspondence and reprint requests to: Yicheng Ni; E-mail: yicheng.ni{at}med.kuleuven.be

Background: Surgical resection is the gold standard in the treatment of resectable colorectal liver metastases (CRLM). In several centers, resection is being replaced by radiofrequency ablation (RFA), even though there is no evidence yet from randomized trials to support this. The aim of this study was to critically review the oncological evidence for and against the use of RFA for resectable CRLM.

Methods: An exhaustive review of RFA of colorectal metastases was carried out.

Results: Five-year survival data after RFA for resectable CRLM are not available. Percutaneous RFA is associated with worse local control, worse staging, and a small risk of electrode track seeding when compared with resection (level V evidence). For tumors 3 cm, local control after surgical RFA is equivalent to resection, especially if applied by experienced physicians to nonperivascular tumors (level V evidence). There is indirect evidence for profoundly different biological effects of RFA and resection.

Conclusions: A subgroup of patients has been identified for whom local control after RFA might be equivalent to resection. Whether this is true, and whether this translates into equivalent survival, remains to be proven. The time has come for a randomized trial.

Key Words: Colorectal liver metastases • Radiofrequency • Resection • Review • Randomized trial

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				V. E. de Meijer, J. N. M. IJzermans, and C. Verhoef A Place for Radiofrequency Ablation in the Treatment of Resectable Colorectal Liver Metastases? Ann. Surg. Oncol., July 1, 2008; 15(7): 2063 - 2063. [Full Text] [PDF]

				S. Mulier, T. Ruers, L. Michel, J. Jamart, G. Marchal, and Y. Ni A Place for Radiofrequency Ablation in the Treatment of Resectable Colorectal Liver Metastases? Ann. Surg. Oncol., July 1, 2008; 15(7): 2064 - 2065. [Full Text] [PDF]