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Percutaneous Radiofrequency Ablation of Colorectal Hepatic Metastases – Initial Experience
An Adjunct Technique to Systemic Chemotherapy for Those with Inoperable Colorectal Hepatic MetastasesWhite T.J.a · Roy-Choudhury S.H.b · Breen D.J.b · Cast J.b · Maraveyas A.c · Smyth E.F.a · Hartley J.E.a · Monson J.R.T.a
aAcademic Surgical Unit, University of Hull, Castle Hill Hospital, Cottingham, and Departments of bRadiology and cOncology, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
Background and Aim: Most patients with hepatic metastases from colorectal carcinoma are unsuitable for resection. Radiofrequency ablation (RFA) has been applied to such lesions at laparotomy. This study aimed to evaluate the less invasive approach of percutaneous RFA. Method: Patients with unresectable liver metastases identified on cross-sectional imaging were considered for percutaneous RFA either alone or in combination with systemic chemotherapy. Subjects with >6 lesions or lesions of maximum size >70 mm were excluded. Percutaneous RFA was applied under sedation and radiological guidance (CT/US). Treatment effect was determined by follow-up imaging. Actuarial survival was calculated by the Kaplan-Meier analysis. Results: Thirty patients (21 males), median age 74.5 years (range 44–85 years), underwent percutaneous RFA to 56 lesions during 54 treatment sessions. The median size of lesion was 30 mm (range 8–70 mm). Fifteen lesions were treated more than once because of recurrence or incomplete ablation. The median ablation time per lesion was 12 min (range 4.5–36 min). Eleven patients had pre-procedural chemotherapy and 15 patients received chemotherapy after treatment. There was minimal associated morbidity (5.6% of treatments). Median hospital stay per treatment was 1 day (range 1–7). Median actuarial survival from the date of first percutaneous RFA was 22 months (95% CI 12.9–31.1 months). Eleven patients were alive at the time of data collection. Conclusion: Percutaneous RFA is a safe, well-tolerated intervention for unresectable hepatic metastases which can be repeated, if required. The technique may be associated with prolonged survival in this selected group of subjects. Future studies should consider the role of percutaneous RFA either in place of or as an adjunct to palliative chemotherapy.
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