Long-term outcomes following hepatic resection and radiofrequency ablation of colorectal liver metastases.

Abstract

Recently some have called for randomized controlled trials comparing RFA to hepatic resection, particularly for patients with only a few small metastases. The objectives were to compare local recurrence and survival following RFA and hepatic resection for colorectal liver metastases. This was a retrospective review of open RFA and hepatic resection for colorectal liver metastases between January 1998 and May 2007. All patients who had RFA were considered to have unresectable disease. 58 patients had hepatic resection and 43 had RFA. A 5-year survival after resection was 43% compared to 23% after RFA. For patients with solitary lesions, a 5-year survival was 48% after resection and 15% after RFA. Sixty percent of patients suffered local recurrences after RFA compared to 7% after hepatic resection. RFA is inferior to resection. The results observed in this study support the consensus that RFA cannot be considered an equivalent procedure to hepatic resection.

AI evidence extraction

Main findings

In this retrospective review, 5-year survival was 43% after hepatic resection versus 23% after RFA; among patients with solitary lesions, 5-year survival was 48% after resection versus 15% after RFA. Local recurrence occurred in 60% of patients after RFA compared with 7% after hepatic resection. The authors conclude RFA was inferior to resection in this cohort.

Outcomes measured

• Local recurrence
• Survival (5-year survival)

Limitations

• Retrospective (non-randomized) design
• Patients receiving RFA were considered to have unresectable disease, indicating potential selection bias and non-comparable groups
• Only open RFA and hepatic resection are described; generalizability to other techniques/settings is unclear from the abstract

{
    "study_type": "cohort",
    "exposure": {
        "band": null,
        "source": "radiofrequency ablation (medical procedure)",
        "frequency_mhz": null,
        "sar_wkg": null,
        "duration": "January 1998 to May 2007"
    },
    "population": "Patients with colorectal liver metastases undergoing open radiofrequency ablation (RFA) or hepatic resection",
    "sample_size": 101,
    "outcomes": [
        "Local recurrence",
        "Survival (5-year survival)"
    ],
    "main_findings": "In this retrospective review, 5-year survival was 43% after hepatic resection versus 23% after RFA; among patients with solitary lesions, 5-year survival was 48% after resection versus 15% after RFA. Local recurrence occurred in 60% of patients after RFA compared with 7% after hepatic resection. The authors conclude RFA was inferior to resection in this cohort.",
    "effect_direction": "harm",
    "limitations": [
        "Retrospective (non-randomized) design",
        "Patients receiving RFA were considered to have unresectable disease, indicating potential selection bias and non-comparable groups",
        "Only open RFA and hepatic resection are described; generalizability to other techniques/settings is unclear from the abstract"
    ],
    "evidence_strength": "low",
    "confidence": 0.7800000000000000266453525910037569701671600341796875,
    "peer_reviewed_likely": "yes",
    "keywords": [
        "radiofrequency ablation",
        "hepatic resection",
        "colorectal liver metastases",
        "local recurrence",
        "5-year survival",
        "retrospective review"
    ],
    "suggested_hubs": []
}

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