Hepatectomy vs radiofrequency ablation for colorectal liver metastasis:A propensity score analysis

AIM:To compare outcomes from radiofrequency ablation(RFA) and hepatectomy for treatment of colorectal liver metastasis(CRLM).METHODS:From January 2000 to December 2009,408 patients underwent curative intent treatment for CRLM.We excluded patients using the criteria:size of CRLM > 3 cm,number of CRLM ≥ 5,percutaneous RFA,follow-up period < 12 mo,double primary cancer,or treatment with both RFA and hepatectomy.We matched 51 patients who underwent RFA with 102 patients who underwent hepatectomy by propensity scores.RESULTS:The median follow-up period was 45 mo(range,12 mo to 158 mo).Hepatic recurrence was more frequent in the RFA than the hepatectomy group(P = 0.021) although extrahepatic recurrence curves were similar(P = 0.716).Survival curves of hepatectomy group were better than that of RFA for multiple,large(> 2 cm) CRLM(P = 0.034).However,survival curves were similar for single or small(≤ 2 cm) CRLM(P = 0.714,P = 0.740).CONCLUSION:Hepatectomy is better than RFA for the treatment of CRLM.However,RFA might be suitable for selected patients with single,small(≤ 2 cm) CRLM.

Repeat hepatic resection in patients with colorectal liver metastases

AIM:To investigate the survival outcomes of secondaryhepatectomy for recurrent colorectal liver metastases(CRLM).METHODS:From October 1994 to December 2009,patients with CRLM who underwent surgical treatment with curative intent were investigated.Patients were divided into two groups:patients who underwent primary hepatectomy(Group 1)and those who underwent secondary hepatectomy for recurrent CRLM(Group 2).RESULTS:Survival and prognostic factors were analyzed.A total of 461 patients were included:406patients in Group 1 and 55 patients in Group 2.After a median 39-mo(range,3-195 mo)follow-up,there was a significant difference between Groups 1 and 2in terms of disease-free survival(P=0.029)although there was no significant difference in overall survival(P=0.206).Secondary hepatectomy was less effective in patients with multiple recurrent CRLM than primary hepatectomy for initial CRLM(P=0.008).Multiple CRLM and radiofrequency ablation therapy were poor prognostic factors of secondary hepatectomy in multivariate Cox regression analysis(P=0.006,P=0.004,respectively).CONCLUSION:Secondary hepatectomy for single recurrent CRLM is as effective as primary surgical treatment for single recurrent CRLM.However,secondary hepatectomy for multiple recurrent CRLM is less effective than that for single recurrent CRLM.