Resection versus resection with ablation: Analysis from the colorectal liver operative metastasis international collaborative

Author:

Mainali Bigyan B.1,Valenzuela Cristian D.2ORCID,Moaven Omeed3,Stauffer John A.4,Del Piccolo Nico R.4,Cheung Tanto5,Corvera Carlos U.6,Wisneski Andrew D.6,Cha Charles H.7,Zarandi Nima P.1,Dourado Justin1,Russell Gregory8,Shen Perry1ORCID

Affiliation:

1. Division of Surgical Oncology, Department of General Surgery Atrium Health Wake Forest Baptist Comprehensive Cancer Center Winston‐Salem North Carolina USA

2. Division of Surgical Oncology OHSU Knight Cancer Institute Portland Oregon USA

3. Division of Surgical Oncology LSU Health New Orleans New Orleans Louisiana USA

4. Division of Hepatobiliary and Pancreatic Surgery Mayo Clinic Florida Jacksonville Florida USA

5. Division Hepatobiliary Surgery, Pancreatic Surgery, and Liver Transplantation University of Hong Kong, Queen Mary Hospital Hong Kong China

6. Division of Hepatobiliary and Pancreatic Surgery University of California San Francisco California USA

7. Division of Surgical Oncology Hartford HealthCare Cancer Institute Bridgeport Connecticut USA

8. Department of Biostatistical Sciences Wake Forest School of Medicine Winston‐Salem North Carolina USA

Abstract

AbstractBackgroundThermal ablation has recently become a key therapy for the treatment of colorectal liver metastasis (CLM). However, the role of ablation in combination with resection has not yet been firmly established. We hypothesize that in patients with CLM, those who undergo liver resection with ablation (RA) have similar outcomes compared with those who undergo liver resection only.MethodsWe reviewed a multicenter international database of 906 surgical procedures for CLM from 5 high volume hepatobiliary surgical units. Patients undergoing RA (n = 63) were matched based on the number of lesions and tumor size using a 1:1 balanced propensity score analysis with those having resection only (n = 63). Our primary outcomes were overall survival (OS) and disease‐free survival (DFS).ResultsThe mean age of our cohort was 58 ± 11 years, with 43% females. With a median follow‐up of 70.8 months, patients in the resection and RA group had a median OS of 45.1 and 54.8 months (p = 0.71), respectively. The median DFS was 22.7 and 14.2 months (p = 0.045), respectively. Using a multivariate Cox proportional hazards regression model, the treatment approach was not associated with OS (p = 0.94) or DFS (p = 0.059). A higher number of lesions is independently associated with worse DFS (hazard ratio: 1.12, p < 0.01). When there was disease recurrence, the region of recurrence was similar between the RA versus resection only groups (p = 0.27), but there was a shorter time to recurrence in the RA group (p = 0.002).ConclusionFor CLM, the treatment approach was not significantly associated with OS or DFS, while tumor biology likely played an important role. Prospective research on the quality and effectiveness of thermal ablation combined with hepatic resection is warranted.

Publisher

Wiley

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