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Salvage RFA in patients with intrahepatic recurrence after major hepatic surgery for colorectal cancer liver metastases: mid-term outcome

  • Markus ZimmermannEmail author
  • Federico Pedersoli
  • Maximilian Schulze-Hagen
  • Georg Lurje
  • Peter Isfort
  • Christiane Kuhl
  • Philipp Bruners
Oncology
  • 21 Downloads

Abstract

Objectives

To evaluate the mid-term outcome of salvage radiofrequency ablation (RFA) treatment in patients who exhibited intrahepatic recurrence after major hepatectomy for colorectal liver metastases (CRCLM).

Methods

Observational study on 23 consecutive patients (mean age 59 ± 9 years; 14/9 male/female) who, after a single (11/23) or multiple rounds (12/23) of major hepatic surgery, developed recurrent CRCLM in the liver remnant. Patients with a maximum of three metastases measuring up to 3 cm, and without relevant extrahepatic disease, underwent CT-guided RFA. Using the Kaplan-Meier-method, median intrahepatic progression-free-survival (ihPFS) and overall survival (OS) times after salvage RFA were compared with the same patients’ time between the respective last round of surgery and diagnosis of intrahepatic recurrence leading to RFA.

Results

Median follow-up was 26 months (range 12–103 months). Median ihPFS time after RFA was 8 months (range 1–81 months). Median ihPFS time after the respective last round of surgery and RFA in the same patients had been 5 months (range 1–23 months), thus yielding similar ihPFS times after surgery vs. after salvage RFA (p = 0.238; Mood’s median test). After RFA, 15/23 (65%) of patients developed new hepatic metastases within the first year post-RFA. Median OS was 37 months, with a 1-year OS rate of 100%, 3-year OS rate of 57%, and 5-year OS rate of 24%. No major complications were observed.

Conclusions

Patients who exhibit intrahepatic recurrence of CRCLM after major hepatectomy will experience intrahepatic recurrence after salvage RFA as well, and after similar time intervals. However, long-term ihPFS may still be achieved in some patients.

Key Points

Patients who exhibit intrahepatic recurrence of colorectal liver metastases after major hepatectomy will experience intrahepatic recurrence after salvage RFA as well, and after similar time intervals.

About two-thirds of all patients develop new metastases elsewhere in the liver within 1 year after RFA.

However, long-term intrahepatic progression-free survival may still be achieved in some patients.

Keywords

Radiofrequency ablation Hepatectomy Colorectal neoplasms Survival analysis 

Abbreviations and acronyms

CRC

Colorectal cancer

CRCLM

Colorectal liver metastases

ihPFS

Intrahepatic progression-free survival

OS

Overall survival

RFA

Radiofrequency ablation

Notes

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Prof. Philipp Bruners.

Conflict of interest

The authors declare that they have no conflict of interest.

Statistics and biometry

The Institute of Medical Statistics of the University Hospital RWTH Aachen kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• observational

• performed at one institution

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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.Department of Diagnostic and Interventional RadiologyUniversity Hospital RWTH AachenAachenGermany
  2. 2.Department of SurgeryRWTH Aachen University HospitalAachenGermany

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