Abstract
Background
The efficacy of combining ablation and resection (CARe) in treating unresectable colorectal
cancer liver metastases (CRLM) was well established. This study aimed to investigate
the surgical and oncological outcomes of CARe strategy focusing on initially resectable
CRLM.
Patients and methods
A total of 971 patients with resectable CRLM from a retrospective database of 1414
CRLM patients were enrolled, including 120 in the CARe group and 851 in the hepatectomy
alone group. Short- and long-term outcomes were compared between groups using propensity
score matching analysis.
Results
After propensity score matching, 96 matched pairs of patients from each group were
included. General characteristics of primary tumour and liver metastases were not
statistically different between the CARe group and hepatectomy alone group. Disease-free
survival (p = 0.257), intrahepatic recurrence-free survival (p = 0.329), and overall
survival (p = 0.358) were similar between the two groups. Patients in CARe group had
significantly reduced rate of major hepatectomy (5.2% vs. 21.9%, p = 0.001), lower
incidence of postoperative hepatic insufficiency (0.0% vs. 5.2%, p = 0.023), and shortened
postoperative hospital stay (7 d vs. 8 d, p = 0.019). Multivariate analysis showed
that surgical approach did not affect oncologic outcome; liver metastasis with diameter
>3 cm was an independent prognostic factor for hepatic recurrence-free and disease-free
survival, and RAS status and lymph node metastasis at the primary site were independent prognostic
factors for overall survival.
Conclusion
For patients with resectable CRLM, CARe may be a better treatment strategy than hepatectomy
alone, as it could avoid major hepatectomy and get better surgical outcomes, while
providing the similar oncologic results.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Surgical OncologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Cancer statistics.CA A Cancer J Clin. 2020; 70 (2020): 7-30
- The management of resectable and unresectable liver metastases from colorectal cancer.Curr Opin Oncol. 2010; 22: 364-373
- Actual 10-year survival after hepatic resection of colorectal liver metastases: what factors preclude cure?.Surgery. 2018; 163: 1238-1244
- Evolution of surgical treatment of colorectal liver metastases in the real world: single center experience in 1212 cases.Cancers. 2021; 13
- A NSQIP review of major morbidity and mortality of synchronous liver resection for colorectal metastasis stratified by extent of liver resection and type of colorectal resection.J Gastrointest Surg. 2015; 19: 1982-1994
- Parenchymal-sparing hepatectomy in colorectal liver metastasis improves salvageability and survival.Ann Surg. 2016; 263: 146-152
- Parenchymal sparing surgery brings treatment of colorectal liver metastases into the precision medicine era.Eur J Cancer. 2018; 104: 195-200
- Local treatment of unresectable colorectal liver metastases: results of a randomized phase II trial.J Natl Cancer Inst. 2017; 109
- Combined ablation and resection (CARe) as an effective parenchymal sparing treatment for extensive colorectal liver metastases.PLoS One. 2014; 9e114404
- Role of thermal ablation in the management of colorectal liver metastasis.Hepatobiliary Surg Nutr. 2020; 9: 49-58
- Propensity score matching demonstrates similar results for radiofrequency ablation compared to surgical resection in colorectal liver metastases.Eur J Surg Oncol. 2022; 4: 1368-1374
- Impact of patient, primary tumor and metastatic pattern including tumor location on survival in patients undergoing ablation or resection for colorectal liver metastases: a population-based national cohort study.Eur J Surg Oncol. 2021; 47: 375-383
- Systematic review and meta-analysis of local ablative therapies for resectable colorectal liver metastases.Eur J Surg Oncol. 2020; 46: 772-781
- Radiofrequency ablation versus resection for technically resectable colorectal liver metastasis: a propensity score analysis.World J Surg Oncol. 2018; 16: 207
- Intraoperative ultrasound staging for colorectal liver metastases in the era of liver-specific magnetic resonance imaging: is it still worthwhile?.JAMA Oncol. 2019; 20191369274
- Parenchymal sparing surgery for colorectal liver metastases: the need for a common definition.Eur J Surg Oncol. 2017; 43: 2285-2291
- Long-term outcomes of radiofrequency ablation combined with hepatectomy compared with hepatectomy alone for colorectal liver metastases.Br J Surg. 2017; 104: 570-579
- "Curettage and aspiration dissection technique" using PMOD for liver resection.HPB (Oxford). 2008; 10: 285-288
- Short- and long-term outcomes of hepatectomy combined with intraoperative radiofrequency ablation for patients with multiple primarily unresectable colorectal liver metastases: a propensity matching analysis.HPB (Oxford). 2021; 23: 1586-1594
- Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.Ann Surg. 2004; 240: 205-213
- Posthepatectomy liver failure: a definition and grading by the international study group of liver surgery (ISGLS).Surgery. 2011; 149: 713-724
- Long-term postoperative survival prediction in patients with colorectal liver metastasis.Oncotarget. 2017; 8: 79927-79934
- Hepatectomy plus intraoperative radiofrequency ablation and chemotherapy to treat technically unresectable multiple colorectal liver metastases.J Surg Oncol. 2005; 90: 36-42
- Colorectal liver metastases: surgery versus thermal ablation (COLLISION) - a phase III single-blind prospective randomized controlled trial.BMC Cancer. 2018; 18: 821
- Preventing futile liver resection: a risk-based approach to surgical selection in major hepatectomy for colorectal cancer.Ann Surg Oncol. 2022; 29: 905-912
- Surgical approach to synchronous colorectal liver metastases: staged, combined, or reverse strategy.Hepatobiliary Surg Nutr. 2020; 9: 25-34
- Liver-first approach for synchronous colorectal metastases: analysis of 7360 patients from the LiverMetSurvey registry.Ann Surg Oncol. 2021; 28: 8198-8208
- Considering the cost of a simultaneous versus staged approach to resection of colorectal cancer with synchronous liver metastases in a publicly funded healthcare model.J Surg Oncol. 2018; 117: 1376-1385
- Simultaneous versus delayed resection for initially resectable synchronous colorectal cancer liver metastases: a prospective, open-label, randomized, controlled trial.Ann Surg. 2021; 273: 49-56
- Simultaneous resection of colorectal cancer with synchronous liver metastases; a practice survey.HPB (Oxford). 2020; 22: 728-734
- Synchronous resection of colorectal cancer primary and liver metastases: an outcomes analysis.HPB (Oxford). 2021; 23: 1277-1284
- Trends and outcomes of simultaneous versus staged resection of synchronous colorectal cancer and colorectal liver metastases.Surgery. 2021; 170: 160-166
- Comparison of simultaneous or delayed liver surgery for limited synchronous colorectal metastases.Br J Surg. 2010; 97: 1279-1289
- ESMO consensus guidelines for the management of patients with metastatic colorectal cancer.Ann Oncol. 2016; 27: 1386-1422
- A single-center retrospective analysis of periprocedural variables affecting local tumor progression after radiofrequency ablation of colorectal cancer liver metastases.Radiology. 2021; 298: 212-218
- Periprocedural risk factors for incomplete radiofrequency ablation of liver metastases from colorectal cancer: a single-center retrospective analysis.Int J Hyperther. 2021; 38: 985-994
- Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases.Ann Surg. 1999; 230 (; discussion 18-21): 309-318
- Is tumor detachment from vascular structures equivalent to R0 resection in surgery for colorectal liver metastases? An observational cohort.Ann Surg Oncol. 2016; 23: 1352-1360
- The liver tunnel: intention-to-treat validation of a new type of hepatectomy.Ann Surg. 2019; 269: 331-336
Article info
Publication history
Published online: May 07, 2023
Accepted:
May 6,
2023
Received in revised form:
March 28,
2023
Received:
December 21,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
