Thermal Ablation Compared to Partial Hepatectomy for Recurrent Colorectal Liver Metastases: An Amsterdam Colorectal Liver Met Registry (AmCORE) Based Study

Abstract

The aim of this study was to assess safety, efficacy and survival outcomes of repeat thermal ablation as compared to repeat partial hepatectomy in patients with recurrent colorectal liver metastases (CRLM). This Amsterdam Colorectal Liver Met Registry (AmCORE) based study of two cohorts, repeat thermal ablation versus repeat partial hepatectomy, analyzed 136 patients (100 thermal ablation, 36 partial hepatectomy) and 224 tumors (170 thermal ablation, 54 partial hepatectomy) with recurrent CRLM from May 2002 to December 2020. The primary and secondary endpoints were overall survival (OS), distant progression-free survival (DPFS) and local tumor progression-free survival (LTPFS), estimated using the Kaplan–Meier method, and complications, analyzed using the chi-square test. Multivariable analyses based on Cox proportional hazards model were used to account for potential confounders. In addition, subgroup analyses according to patient, initial and repeat local treatment characteristics were performed. In the crude overall comparison, OS of patients treated with repeat partial hepatectomy was not statistically different from repeat thermal ablation (p = 0.927). Further quantification of OS, after accounting for potential confounders, demonstrated concordant results for repeat local treatment (hazard ratio (HR), 0.986; 95% confidence interval (CI), 0.517–1.881; p = 0.966). The 1-, 3- and 5-year OS were 98.9%, 62.6% and 42.3% respectively for the thermal ablation group and 93.8%, 74.5% and 49.3% for the repeat resection group. No differences in DPFS (p = 0.942), LTPFS (p = 0.397) and complication rate (p = 0.063) were found. Mean length of hospital stay was 2.1 days in the repeat thermal ablation group and 4.8 days in the repeat partial hepatectomy group (p = 0.009). Subgroup analyses identified no heterogeneous treatment effects according to patient, initial and repeat local treatment characteristics. Repeat partial hepatectomy was not statistically different from repeat thermal ablation with regard to OS, DPFS, LTPFS and complications, whereas length of hospital stay favored repeat thermal ablation. Thermal ablation should be considered a valid and potentially less invasive alternative for small-size (0–3 cm) CRLM in the treatment of recurrent new CRLM. While, the eagerly awaited results of the phase III prospective randomized controlled COLLISION trial (NCT03088150) should provide definitive answers regarding surgery versus thermal ablation for CRLM.

Comparison of high-intensity focused ultrasound and microwave ablation for the treatment of small liver metastatic tumors

“…Local ablation has been shown to significantly increase survival time and enhance the quality of life for patients with liver metastatic tumors, with fewer complications and shorter hospital stays compared with surgical treatment. 10 For example, HIFU ablation of 47 patients with liver tumors <3 cm in diameter resulted in a tumor ablation rate of 87.2%. 11 And in a retrospective study, Zhang et al 12 compared the therapeutic efficacy of percutaneous RFA to MWA in liver tumor 5 cm in diameter by evaluating 155 patients.…”

Local Treatments in the Unresectable Patient with Colorectal Cancer Metastasis: A Review from the Point of View of the Medical Oncologist

“…Prospective evidence by Dijkstra et al, in contrast, found no difference between LPFS, distant-PFS or OS between RFA and surgery in patients with mostly single metastases (64.5% of patients) and with small lesions < 3 cm (84% of patients). There were no difference in complications but significantly smaller hospital stay in patients treated with RFA [ 75 ].…”

Multidisciplinary Tumor Board in the Management of Patients with Colorectal Liver Metastases: A Single-Center Review of 847 Patients

“…Recently, increasing attention has been focused on multimodal treatment strategies, meaning that the single or repeated applications of locoregional and systemic therapies are considered potentially more effective in providing long-term survival than chemotherapy alone [ 13 , 14 ]. Indeed, good results have been reported using ablative techniques or transarterial therapies, which, as an alternative to or in combination with systemic therapy for CRLMs patients [ 15 , 16 , 17 , 18 ], can also be applied to patients with CRLMs recurrence after a given previous locoregional treatment [ 19 , 20 ].…”