Outcome of combined partial liver resection and intraoperative radiofrequency ablation in colorectal liver metastases

Background
Liver metastases occur in 40% of patients with colorectal cancer. A minority of the patients are eligible for resection, with 5-year survival rates of 18–38%. Intraoperative radiofrequency ablation (IRFA) could be an alternative for resection to reduce loss of liver remnant. A median survival of 36 months was achieved by using multidisciplinary approach, doubling the survival rate.
Patients and methods
This is a prospective consecutive study. Between June 2016 and June 2018, 32 patients with colorectal liver metastases (CRLM) were divided into group A, comprising 15 patients with unilateral CRLM that can be resected with adequate residual volume, and group B, comprising 17 patients with unilateral CRLM that cannot be resected, but they are still eligible for complete hepatic clearance using combined liver resection and IRFA. All were followed up for 6 months.
Results
Fifteen patients underwent anatomical liver resection and 17 patients had partial resection combined with IRFA. The Clavien’s complication rate was significantly lower in group B (35%) vs 60% in group A, and most complications were minor. Only two patients in group A had a grade III complication, where they underwent pigtail insertion for biliary leakage. Liver progress in IRFA group was seen in one patient. Liver recurrence was seen in 13 and 17.5% in groups A and B, respectively. During the first 3 months, complete hepatic response was observed in 14 patients in group A and 15 patients in group B (93 and 88%, respectively). After 6 months, all patients were alive, without liver tumor burden in 11 (73%) patients in group A and 17 (70%) patients in group B, but three patients developed colonic tumor recurrence.
Conclusion
Combined IRFA and liver resection augments the number of patients who can be treated surgically.