Top

European Radiology

Published in:

24-08-2022 | Metastasis | Gastrointestinal

Thermal ablation versus hepatic resection for colorectal cancer with synchronous liver metastases: a propensity score matching study

Authors: Yun Xu, Yuqin Zhang, Charlie Zhilin Zheng, Cong Li, Tian’an Guo, Ye Xu

Published in: European Radiology | Issue 10/2022

Abstract

Objectives

Several studies have compared the efficacy of hepatic resection (HR) and thermal ablation (TA) for unresectable tumors; however, results remain inconsistent. Most cohorts in previous studies were heterogeneous groups of synchronous colorectal liver metastases (CRLM) and extrahepatic metastases. This retrospective study aimed to compare the therapeutic efficacy between TA and HR in synchronous CRLM without extrahepatic metastases.

Methods

Cases with initially synchronous CRLM without extrahepatic metastases between January 2007 and December 2018 were enrolled. Of the 448 cases, 346 received HR and 102 TA. Propensity score matching with a 1:1 ratio was used to improve the comparability between the HR and TA groups. Technical success, complications, disease-free survival (DFS), and overall survival (OS) were compared before and after matching.

Results

All patients achieved technical success. Major complication rates in the HR and TA groups were, respectively, 36.7% and 8.8% (p < 0.001). Before matching, the 5-year OS and DFS (p = 0.004 and p = 0.020, respectively) were significantly higher in the HR group than in the TA group. After matching, no significant difference in the 5-year OS and DFS was found between the groups (p = 0.770 and p = 0.939, respectively). Local tumor progression rate was significantly higher in the TA group both before (p = 0.027) and after (p = 0.029) matching.

Conclusions

For patients with CRC with synchronous CRLM, TA and HR provide comparable OS and DFS. TA is preferable if complete ablation is predicted.

Key Points

• Thermal ablation and hepatic resection provide comparable overall survival and disease-free survival.

• Thermal ablation is a safe and effective treatment for patients with colorectal cancer with synchronous liver metastases and has a lower major complication rate and higher repeatability than hepatic resection.

• Thermal ablation is preferable if complete ablation is predicted.

Available only for authorised users

Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68:394–424PubMed

Gillams A, Goldberg N, Ahmed M et al (2015) Thermal ablation of colorectal liver metastases: a position paper by an international panel of ablation experts, The Interventional Oncology Sans Frontières meeting 2013. Eur Radiol 25:3438–3454CrossRef

Engstrand J, Nilsson H, Strömberg C, Jonas E, Freedman J (2018) Colorectal cancer liver metastases - a population-based study on incidence, management and survival. BMC Cancer 18:78CrossRef

Elias D, Viganò L, Orsi F et al (2016) New perspectives in the treatment of colorectal metastases. Liver Cancer 6:90–98CrossRef

Ahmed M, Brace CL, Lee FT Jr, Goldberg SN (2011) Principles of and advances in percutaneous ablation. Radiology 258:351–369CrossRef

Sucandy I, Cheek S, Golas BJ, Tsung A, Geller DA, Marsh JW (2016) Longterm survival outcomes of patients undergoing treatment with radiofrequency ablation for hepatocellular carcinoma and metastatic colorectal cancer liver tumors. HPB (Oxford) 18:756–763CrossRef

Shady W, Petre EN, Gonen M et al (2016) Percutaneous radiofrequency ablation of colorectal cancer liver metastases: factors affecting outcomes--a 10-year experience at a single center. Radiology 278:601–611CrossRef

Nieuwenhuizen S, Puijk RS, van den Bemd B, et al (2020) Resectability and ablatability criteria for the treatment of liver only colorectal metastases: multidisciplinary consensus document from the COLLISION trial group. Cancers (Basel) 1779. https://doi.org/10.3390/cancers12071779

Vasiniotis Kamarinos N, Sofocleous CT (2020) Imaging and image-guided thermal ablation for oligometastatic colorectal cancer liver disease. Cancer J 26:124–128CrossRef

10.

McEachron KR, Ankeny JS, Robbins A et al (2021) Surgical microwave ablation of otherwise non-resectable colorectal cancer liver metastases: expanding opportunities for long term survival. Surg Oncol 36:61–64CrossRef

11.

Reuter NP, Woodall CE, Scoggins CR, McMasters KM, Martin RC (2009) Radiofrequency ablation vs. resection for hepatic colorectal metastasis: therapeutically equivalent? J Gastrointest Surg 13:486–491CrossRef

12.

Minami Y, Kudo M (2013) Radiofrequency ablation of liver metastases from colorectal cancer: a literature review. Gut Liver 7:1–6CrossRef

13.

Imai K, Allard MA, Castro Benitez C et al (2017) Long-term outcomes of radiofrequency ablation combined with hepatectomy compared with hepatectomy alone for colorectal liver metastases. Br J Surg 104:570–579CrossRef

14.

Lei P, Ruan Y, Tan L, Wei H, Chen T (2020) Laparoscopic colorectal resection combined with simultaneous thermal ablation or surgical resection of liver metastasis: a retrospective comparative study. Int J Hyperth 37:137–143CrossRef

15.

Yang G, Wang G, Sun J et al (2021) The prognosis of radiofrequency ablation versus hepatic resection for patients with colorectal liver metastases: a systematic review and meta-analysis based on 22 studies. Int J Surg 87:105896. https://doi.org/10.1016/j.ijsu.2021.105896CrossRefPubMed

16.

Tinguely P, Dal G, Bottai M, Nilsson H, Freedman J, Engstrand J (2020) Microwave ablation versus resection for colorectal cancer liver metastases - a propensity score analysis from a population-based nationwide registry. Eur J Surg Oncol 46:476–485CrossRef

17.

van Amerongen MJ, van der Stok EP, Fütterer JJ et al (2019) Results after simultaneous surgery and RFA liver ablation for patients with colorectal carcinoma and synchronous liver metastases. Eur J Surg Oncol 45:2334–2339CrossRef

18.

Dupré A, Jones RP, Diaz-Nieto R, Fenwick SW, Poston GJ, Malik HZ (2017) Curative-intent treatment of recurrent colorectal liver metastases: a comparison between ablation and resection. Eur J Surg Oncol 43:1901–1907CrossRef

19.

Xu Y, Shen Q, Wang N et al (2017) Percutaneous microwave ablation of 5-6 cm unresectable hepatocellular carcinoma: local efficacy and long-term outcomes. Int J Hyperth 33:247–254CrossRef

20.

Xu Y, Shen Q, Liu P et al (2017) Microwave ablation for the treatment of hepatocellular carcinoma that met up-to-seven criteria: feasibility, local efficacy and long-term outcomes. Eur Radiol 27:3877–3887CrossRef

21.

Xu Y, Shen Q, Wang N et al (2017) Microwave ablation is as effective as radiofrequency ablation for very-early-stage hepatocellular carcinoma. Chin J Cancer 36:14CrossRef

22.

Teratani T, Yoshida H, Shiina S et al (2006) Radiofrequency ablation for hepatocellular carcinoma in so-called high-risk locations. Hepatology 43:1101–1108CrossRef

23.

Howard C, Clements TW, Edwards JP et al (2018) Synchronous colorectal liver metastases: a national survey of surgeon opinions on simultaneous resection and multidisciplinary cooperation. Hepatobiliary Surg Nutr 7:242–250CrossRef

24.

Boudjema K, Locher C, Sabbagh C et al (2021) Simultaneous versus delayed resection for initially resectable synchronous colorectal cancer liver metastases: a prospective, open-label, randomized, controlled trial. Ann Surg 273:49–56CrossRef

25.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRef

26.

Kurilova I, Bendet A, Petre EN et al (2020) Factors associated with local tumor control and complications after thermal ablation of colorectal cancer liver metastases: a 15-year retrospective cohort study. Clin Colorectal Cancer S1533-0028(20):30134–30131. https://doi.org/10.1016/j.clcc.2020.09.005CrossRef

27.

Laimer G, Jaschke N, Schullian P et al (2021) Volumetric assessment of the periablational safety margin after thermal ablation of colorectal liver metastases. Eur Radiol https://doi.org/10.1007/s00330-020-07579-x

28.

Vasiniotis Kamarinos N, Sofocleous CT (2020) Role of image-guided percutaneous thermal ablation in the management of colorectal cancer liver metastases. Hepatobiliary Surg Nutr 9:235–238CrossRef

29.

Cucchetti A, Zhong J, Berhane S et al (2020) The chances of hepatic resection curing hepatocellular carcinoma. J Hepatol 72:711–717CrossRef

30.

Franzese C, Comito T, Clerici E et al (2018) Liver metastases from colorectal cancer: propensity score-based comparison of stereotactic body radiation therapy vs. microwave ablation. J Cancer Res Clin Oncol 144:1777–1783CrossRef

Title: Thermal ablation versus hepatic resection for colorectal cancer with synchronous liver metastases: a propensity score matching study
Authors: Yun Xu
Yuqin Zhang
Charlie Zhilin Zheng
Cong Li
Tian’an Guo
Ye Xu
Publication date: 24-08-2022
Publisher: Springer Berlin Heidelberg
Keywords: Metastasis
Colorectal Cancer
Colorectal Cancer
Published in: European Radiology / Issue 10/2022
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-022-09080-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Thermal ablation versus hepatic resection for colorectal cancer with synchronous liver metastases: a propensity score matching study

Abstract

Objectives

Methods

Results

Conclusions

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key Points

Please log in to get access to this content

Other articles of this Issue 10/2022

The role of computer-assisted radiographer reporting in lung cancer screening programmes

Performance of novel deep learning network with the incorporation of the automatic segmentation network for diagnosis of breast cancer in automated breast ultrasound

Long-term outcomes of transarterial embolization with lipiodol–bleomycin emulsion plus polyvinyl alcohol particles versus the particles alone for large symptomatic focal nodular hyperplasia: a propensity score–matched analysis

The awareness of radiologists for the presence of lateral lymph nodes in patients with locally advanced rectal cancer: a single-centre, retrospective cohort study

Comparison of utility of deep learning reconstruction on 3D MRCPs obtained with three different k-space data acquisitions in patients with IPMN

Machine learning for the automatic assessment of aortic rotational flow and wall shear stress from 4D flow cardiac magnetic resonance imaging