Open Surgical is Superior to Percutaneous Access for Radiofrequency Ablation of Hepatic Metastases

This study was designed to determine the best approach to radiofrequency ablation (RFA) in the liver.

From a total of 41 procedures, 37 patients with 47 tumors were treated with RFA for metastatic disease. Indications included colorectal cancer (n = 28, 68%), neuroendocrine tumors (n = 2, 5%), gynecological primaries (n = 4, 10%), pancreatic/duodenal cancer (n = 2, 5%), and miscellaneous entities (n = 5, 12%). Mean follow-up period was 18 (median, 18) months. All ways of approach to RFA were applied: percutaneous was chosen in 17 (41.5%), laparoscopic and hand-assisted laparoscopic in 5 (12.2%), and open surgical in 19 cases (46.3%), and in 10 cases, RFA was combined with hepatic resection. The average maximum tumor size was 2.3 (range, 0.8–6) cm, and the mean number of nodules treated per patient in a single session was 1.3 (range, 1–3).

Overall survival was 59.5% at 2 years, recurrence-free 2-year survival was 12.6%, local tumor recurrence rate was 34%, and overall recurrence was 75.6%. Local tumor recurrence and disease-free survival were significantly improved in the open surgically treated patients compared with the percutaneous treatment group (15.8% [n = 3] vs. 58.8% [n = 10] and 11.5 vs. 7.9 months, p < 0.01 [χ² test] and p < 0.05 [log-rank test], respectively).

Open surgical approach is superior to percutaneous access for RFA in metastatic hepatic disease.