NEW YORK (Reuters Health) – In colorectal cancer patients, ablation of bilateral hepatic metastases with or without surgery compares well to the gold standard approach of bilateral resection, according to a report from Memorial Sloan-Kettering Cancer Center in New York.

“Patients treated with ablation, either alone or in combination with resection, had less intraoperative blood loss, similar perioperative mortality, shorter length of hospitalization, and similar overall 5-year survival,” the researchers found.

As they pointed out in their paper in JAMA Surgery published online May 8, there is a “compelling need” to further define the usefulness of ablation in patients with colorectal liver metastases.

Dr. Yuman Fong and colleagues used their center’s database to look at outcomes in 95 patients with bilateral colorectal liver metastases who were treated with radiofrequency or microwave ablation with or without resection between 2004 and 2008. This group was compared to 141 patients who underwent conventional bilateral resection before 2004, i.e. prior to the introduction of ablation, in order to minimize patient selection bias inherent in more recent data.

While median operative times were similar in both groups, other perioperative outcomes favored the ablation group over the bilateral resection cohort. Blood loss was less (300 mL vs 500 mL; p <0.01) and length of stay was shorter (7 days vs 9 days; p<0.01), according to the report.

Furthermore, despite a poorer Clinical Risk Score in the ablation cohort, 5-year overall survival in the two groups was similar at 56% with ablation versus 49% with bilateral resection (p=0.16).

Summing up, Dr. Fong and colleagues concluded, “Treatment of bilateral, multiple hepatic metastases with combined resection and ablation was associated with improved perioperative outcomes without compromising long-term survival compared with bilateral resection.”

They did note, though, that ideally the two strategies should be compared in a randomized trial; however, that would be difficult because of the “intuitive” selection of patients for ablation or resection. “In general, patients with multiple tumors confined to one region of the liver or with large solitary metastases should undergo resection. Ablation in these settings would be, at best, inefficient and, at worst, ineffective. In contrast, ablation may play a role for patients with a limited number of small metastases deep within the hepatic parenchyma.”

SOURCE: Long-term Outcomes Following Tumor Ablation for Treatment of Bilateral Colorectal Liver Metastases
JAMA Surg 2013.