Radiofrequency ablation of unresectable colorectal liver metastases: trends in management and outcome during a decade at a single center.

Background: Radiofrequency ablation (RFA) is widely used for treatment of colorectal liver metastases (CRLM).

Purpose: To evaluate the effect of increased experience in RFA of CRLM on morbidity and survival, and the trends in patient management and outcomes during the last decade.

Material And Methods: Hospital records of the initial 52 consecutive patients who underwent RFA (56 procedures/70 lesions) were retrospectively reviewed. The patients were divided into two groups according to time period of treatment, period I (2001-2006: n = 26) and period II (2007-2011: n = 26).

Results: Concomitant liver resection was performed in 15 patients in each period. Operative morbidity decreased from 47% to 19% (P = 0.047). Most complications were found in patients who underwent a concomitant liver resection and not related to the ablation per se. Local recurrence rate decreased from 19.4% to 12.9% (P = 0.526). At least one risk factor for recurrence was found in patients with local recurrence (n = 11): subcapsular localization (n = 4), tumor size >3 cm and subcapsular localization (n = 2), and perivascular localization (portal veins/hepatic veins) (n = 5). Median overall survival was 32 months in period I and 49 months in period II, whereas estimated 5-year survival was 19% and 36%, respectively (P = 0.09). Adjuvant chemotherapy was given to four patients (15.4%) in period I and 13 patients (50%) in period II (P = 0.017).

Conclusion: RFA alone or in combination with liver resection is a potentially curative treatment to selected patients with CRLM. Over time, the morbidity and survival have improved in RFA of CRLM. Although a possible effect of a learning curve should be taken into consideration in the appraisal of this improvement, it is more likely to be attributable to optimization of indication, development in surgical techniques, and increased use of perioperative chemotherapy.