Percutaneous stereotactic radiofrequency ablation of colorectal liver metastases

Abstract

Large colorectal liver metastases can be effectively treated by stereotactic radiofrequency ablation (SRFA). Using SRFA the overall survival is not affected by tumour size. SRFA achieves similar overall and disease-free survival rates as surgical resection. SRFA challenges surgical resection as the first-line treatment for colorectal liver metastases.

Designing Liver Resections and Pushing the Envelope with Resections for Hepatic Colorectal Metastases

“…Ablation is an effective option for patients who are not candidates for hepatic resection due to inadequate FLR or patient co-morbidities [51]. Other criteria for the use of ablation include fewer than 3 CRLM and hepatic tumor size less than 3 cm [52,53]. Although the use of ablative techniques is popular and safer in some patients when compared with surgical resection, ablation results in higher local recurrence rates [8,[52][53][54].…”

“…Other criteria for the use of ablation include fewer than 3 CRLM and hepatic tumor size less than 3 cm [52,53]. Although the use of ablative techniques is popular and safer in some patients when compared with surgical resection, ablation results in higher local recurrence rates [8,[52][53][54]. Radiofrequency ablation (RFA) is the most commonly-used ablation technique used currently and can be used to ablate residual unresectable disease as well as to treat small hepatic recurrences [8,52,53,55].…”

“…Although the use of ablative techniques is popular and safer in some patients when compared with surgical resection, ablation results in higher local recurrence rates [8,[52][53][54]. Radiofrequency ablation (RFA) is the most commonly-used ablation technique used currently and can be used to ablate residual unresectable disease as well as to treat small hepatic recurrences [8,52,53,55]. Other ablation technologies include cryoablation, microwave ablation (MWA) [56], and the newest, most recent option, irreversible electroporation (NanoKnife System, AngioDynamics, Latham, NY, USA); however a detailed discussion of these techniques is outside the scope of this review.…”

Resection and Ablation for Colorectal Liver Metastases

“…Experience with RFA determines complete ablation and post-operative morbidities, as demonstrated by Poon et al [20]. On the other hand, Bale and colleagues demonstrated that experience did not influence treatment outcome of stereotactic radiofrequency ablation as the technology allows accurate multiple needle placements, however, with compromised complication rates of up to 17% [21,22].…”

“…A wide range of morbidity rates following RFA for unresectable CLMs have been reported, ranging from 1.7% to 27% [13,15,[22][23][24]26,30,37,47]. Morbidity following RFA is inversely proportional to the experience of the proceduralist [4].…”