The Importance of Optimal Thermal Ablation Margins in Colorectal Liver Metastases: A Systematic Review and Meta-Analysis of 21 Studies

Colorectal cancer (CRC) is the second most common cause of cancer-related deaths in the US. Thermal ablation (TA) can be a comparable alternative to partial hepatectomy for selected cases when eradication of all visible tumor with an ablative margin of greater than 5 mm is achieved. This systematic...

Full description

Saved in:
Bibliographic Details
Published in:Cancers 2023-12, Vol.15 (24), p.5806
Main Authors: Chlorogiannis, David-Dimitris, Sotirchos, Vlasios S, Georgiades, Christos, Filippiadis, Dimitrios, Arellano, Ronald S, Gonen, Mithat, Makris, Gregory C, Garg, Tushar, Sofocleous, Constantinos T
Format: Article
Language:English
Subjects:
Ablation
Ablation (Surgery)
Asymmetry
Cancer
Colorectal cancer
Colorectal carcinoma
Data analysis
Development and progression
Eradication
Health aspects
Hepatectomy
Liver
Liver cancer
Long-term potentiation
Malignancy
Meta-analysis
Metastases
Metastasis
Sensitivity analysis
Software
Statistical analysis
Systematic review
Tumors
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Colorectal cancer (CRC) is the second most common cause of cancer-related deaths in the US. Thermal ablation (TA) can be a comparable alternative to partial hepatectomy for selected cases when eradication of all visible tumor with an ablative margin of greater than 5 mm is achieved. This systematic review and meta-analysis aimed to encapsulate the current clinical evidence concerning the optimal TA margin for local cure in patients with colorectal liver metastases (CLM). MEDLINE, EMBASE, and the CENTRAL databases were systematically searched from inception until 1 May 2023, in accordance with the PRISMA Guidelines. Measure of effect included the risk ratio (RR) with 95% confidence interval (CI) using the random-effects model. Overall, 21 studies were included, comprising 2005 participants and 2873 ablated CLMs. TA with margins less than 5 mm were associated with a 3.6 times higher risk for LTP (n = 21 studies, RR: 3.60; 95% CI: 2.58-5.03; -value < 0.001). When margins less than 5 mm were additionally confirmed by using 3D software, a 5.1 times higher risk for LTP (n = 4 studies, RR: 5.10; 95% CI: 1.45-17.90; -value < 0.001) was recorded. Moreover, a thermal ablation margin of less than 10 mm but over 5 mm remained significantly associated with 3.64 times higher risk for LTP vs. minimal margin larger than 10 mm (n = 7 studies, RR: 3.64; 95% CI: 1.31-10.10; -value < 0.001). This meta-analysis solidifies that a minimal ablation margin over 5 mm is the minimum critical endpoint required, whereas a minimal margin of at least 10 mm yields optimal local tumor control after TA of CLMs.
ISSN:2072-6694
2072-6694
DOI:10.3390/cancers15245806