Intraoperative radiofrequency ablation (RFA) for irresectable liver malignancies
Introduction
Liver metastases of colorectal carcinoma are the most common secondary liver malignancies. Since the first resection of such tumours was performed in 19401 it has become generally accepted that resection offers the best therapeutic option. Five year survival rates of 35–45% after primary resection2., 3., 4. and of 21–57% after repeated resection5., 6., 7. have been reported. Completeness of tumour removal, number of lesions and tumour size have significant influence on survival.6., 7. The benefits of resection have been demonstrated also for patients with hepatic metastases of other origin.8., 9., 10., 11.
Due to extrahepatic disease or intrahepatic growth pattern only 10–25% of all patients with colorectal liver metastases are candidates for surgery.12., 13., 14. For all other patients treatment is palliative although a variety of cytostatic drugs have been studied and the role of novel agents is yet to be defined.15 Intratumoural ethanol injection, cryoablation, radiofrequency ablation (RFA), microwave ablation, laser induced thermo ablation (LITT) and high intensity focused ultrasound have been tested as therapeutic option to control disease in irresectable patients or as adjunct to liver surgery.16 RFA applied intraoperatively at open or laparoscopic surgery or percutaneously has been shown to be a relatively safe procedure by which effective local tumour control can be achieved.17., 18. It appears to bear less complications compared to cryoablation19 and is easier to apply intraoperatively than LITT. Nevertheless its precise role is still to be defined. We have used RFA during the past three years intraoperatively in patients assessed as irresectable. The aim of this study was to report the results for its use in open surgery.
Section snippets
Methods
In this study 26 patients (nine female, 17 male) from August 2000 to September 2003 with hepatic malignancies were included who either underwent explorative laparotomy and were found to be irresectable and received RFA or in whom resectability was already ruled out preoperatively and percutaneous RFA was not feasible. In some of the former cases (n=11) RFA was combined with simultaneous liver resection.
For RFA an expandable electrode with temperature control (RITA Medical Systems, USA) was
Patients and treatment
Patients age ranged from 24 to 72 years (median 61). Twenty-one patients had undergone operative therapy previously: 17 for colorectal cancer, one each for hepatocellular carcinoma, for adenocarcinoma of the endometrium, for leiomyosarcoma and for renal cell carcinoma. One patient each with liver metastasis (adenocarcinoma) of unknown primary (CUP-syndrome), with colorectal cancer and liver metastasis, with cholangiocarcinoma, with hepatocellular carcinoma and with metastasized
Discussion
Liver resection remains to be the best curative option for most hepatic malignancies, especially colorectal liver metastases. But due to size and distribution of tumour only a minority of these patients is resectable.12., 13., 14. Although imaging modalities have been improved tremendously throughout the past years the definitive identification of irresectable patients pre-operatively is often impossible.20 In these cases, an explorative laparotomy is performed. If it reveals irresectability
Conclusion
Intraoperative RFA alone or in combination with liver resection is a valuable new tool which extends the spectrum of liver surgery in cases where complete resection is not possible.
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Cited by (44)
Other non-surgical treatments for liver cancer
2017, Reports of Practical Oncology and RadiotherapyLiver-directed therapies in colorectal cancer
2011, Seminars in OncologyCitation Excerpt :Data on the survival benefit of RFA have been similarly contradictory. Some studies have reported 5-year survival of less than 20% following RFA, whereas other studies have reported 5-year survival rates in the range of 30% or more (Table 2 and Figure 1).22-33 In a recent Clinical Evidence Review by the American Society of Clinical Oncology on RFA of CRLM, the authors acknowledged a paucity of quality evidence and emphasized a compelling need for more clinical trials to determine the efficacy and utility of RFA for these patients.
Complications of intraoperative radiofrequency ablation of liver metastases
2011, HPBCitation Excerpt :Different types of vascular complication were described in 11 articles in a total of 22 patients.9,18,19,22,23,25,26,31,32,34,38 Associated procedures such as cholecystectomy or colectomy induced six haemorrhages, two of which were fatal25,31 and one required re-operation after prophylactic cholecystectomy.38 Three haemorrhages from the needle track were treated during surgery18 by compression.
Results of liver resection in combination with radiofrequency ablation for hepatic malignancies
2010, European Journal of Surgical OncologyCitation Excerpt :The presented series shows a successful extension of the feasibility of surgical treatment of liver tumors using the combination of liver resection and RFA. These findings resemble some results reported in the literature11–23 on this treatment approach with limited complications and increased survival. Table 2 provides an overview of reports on such a combined treatment.
Radiofrequency Ablation and Biopsy of Metastatic Pheochromocytoma: Emphasizing Safety Issues and Dangers
2009, Journal of Vascular and Interventional Radiology