Aims and objectives
Untreated hepatic metastatic disease has a 5 year survival of almost 0% (12).
Current treatment strategies including surgery and interventional radiological techniques such as embolisation and thermal ablation,
have lead to significant improvements in outcomes.
The exact role of these techniques remains a matter of debate.
Surgery carries significant mortality (0-2%) and morbidity (5-16%) rates (14),
with large numbers of patients failing to complete invasive and intensive treatment regimes....
Methods and materials
51 tumours in 31 patients treated with radiofrequency ablation (RFA) between 2009 and 2013 during 44 separate procedures were analysed using a prospective database. All ablation procedures were performed under deep conscious sedation with local anaesthetic infiltrated to the hepatic capsule under US guidance..
Ablation was completed using either the Boston Scientific LeVeen needle (Natuck,
USA) or the Covidien Cool-tip system (Mansfield,
using a single,
double or triple needle...
Survival Median survival was 72 weeks,
and 3-year survival 90.3%,
72.3% and 65% respectively. Patients with tumours >30mm had a mean survival of 96 weeks,
compared to 180 weeks in smaller lesions (p=0.009) (figure 1). Patients who received pre-RFA chemotherapy had mean survival of 180 weeks,
compared to 101 weeks in those who had not (p=0.033) (figure 2). Patients with maximum tumour diameter less than 30mm in whom lesions were located distant to both hepatic vessels and biliary...
Accessible liver metastases,
<30mm in diameter and distant from hepatic vasculature and biliary structures could be considered for initial RFA treatment rather than surgery,
minimising morbidity and loss of liver volume. Pre-RFA chemotherapy can improve survival in selected patients. 3-year survival of 65% compares favourably with liver resection alone (4) (6) (9) (10),
suggesting that RFA is equivalent to resection in patients with resectable disease. The initial number of lesions treated...
Dr Stuart Forbes,
Department of Surgery, Ipswich Hospital,
01473 712233 2.
Dr Christopher Zagorski,
Department of Radiology Norfolk and Norwich University Hospital,
01603 286286 3.
Dr Paul Jennings,
Department of Radiology Ipswich Hospital,
01473 712233 4.
Dr Rubin Soomal,
Department of Oncology Ipswich Hospital,
01473 712233 5.
Dr Simon Smith,
van Tilborg AAJM,
Meijerink M et al (2013) Incidence and Treatment of Local Site Recurrences Following RFA of Colorectal Liver Metastases.
World J Surg 37: 1340-1347 Siperstein AE,
Ballem N et al (2007) Survival after radiofrequency ablation of colorectal liver metastases: 10 year experience.
Ann Surg 246: 559-565 Van Tilborg AAJM,
Sietses C et al (2011) Long term results of radiofrequncy ablation for unresectable colorectal liver metastases: a potentially...