Patterns of Recurrence After Ablation of Colorectal Cancer Liver Metastases

• Published in: Annals of surgical oncology 2012-03, Vol.19 (3), p.834-841
• Main Authors: Kingham, T. Peter, Tanoue, Michael, Eaton, Anne, Rocha, Flavio G., Do, Richard, Allen, Peter, De Matteo, Ronald P., D’Angelica, Michael, Fong, Yuman, Jarnagin, William R.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Catheter Ablation; Chemoradiotherapy, Adjuvant; Colorectal cancer; Colorectal Neoplasms - pathology; Female; Hepatectomy; Hepatobiliary Tumors; Humans; Liver Neoplasms - mortality; Liver Neoplasms - secondary; Liver Neoplasms - surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Oncology; Surgery; Surgical Oncology; Survival Rate
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-011-2048-x

Purpose To determine the local recurrence rate and factors associated with recurrence after intraoperative ablation of colorectal cancer liver metastases. Methods A retrospective analysis of a prospectively maintained database was performed for patients who underwent ablation of a hepatic colorectal cancer metastasis in the operating room from April 1996 to March 2010. Kaplan-Meier survival curves and Cox models were used to determine recurrence rates and assess significance. Results Ablation was performed in 10% ( n  = 158 patients) of all cases during the study period. Seventy-eight percent were performed in conjunction with a liver resection. Of the 315 tumors ablated, most tumors were ≤1 cm in maximum diameter (53%). Radiofrequency ablation was used to treat most of the tumors (70%). Thirty-six tumors (11%) had local recurrence as part of their recurrence pattern. Disease recurred in the liver or systemically after 212 tumors (67%) were ablated. On univariate analysis, tumor size greater than 1 cm was associated with a significantly increased risk of local recurrence (hazard ratio 2.3, 95% confidence interval 1.2–4.5, P  = 0.013). The 2 year ablation zone recurrence-free survival was 92% for tumors ≤1 cm compared to 81% for tumors >1 cm. On multivariate analysis, tumor size of >1 cm, lack of postoperative chemotherapy, and use of cryotherapy were significantly associated with a higher local recurrence rate. Conclusions Intraoperative ablation appears to be highly effective treatment for hepatic colorectal tumors ≤1 cm.