Surgery or RFA for Liver Mets?

Both surgery and radiofrequency ablation (RFA) are used to destroy liver tumors that have spread from colorectal cancer, but which approach is better?

Surgeons at the University of Louisville School of Medicine reviewed all the cases where patients received either surgery only or RFA only in their hospital over the past twelve years.  They had over 1,100 cases involving liver tumors during that time, and 192 involved either a single liver surgery or only radiofrequency ablation.

They found the time before cancer came back was considerably shorter for RFA.  In addition, cancer returned at the RFA or surgical site more often for RFA, and also recurred more often elsewhere in the liver.

Both groups of patients — those who received RFA and those who had surgery to remove liver tumors — were similar in the extent of cancer in their liver and the number of tumors.  The percentage who had cancer outside the liver was also very similar.  About 60 to 67 percent had chemotherapy previously.

Comparing the two approaches:

  • Time to recurrence anywhere in the body was 12.2 months for RFA and 31.1 months for surgery.
  • Seventeen percent of RFA patients had cancer return at the treatment site compared to two percent of surgical patients.
  • Thirty-three percent of RFA patients had cancer return somewhere else in their liver compared to 14 percent of those who had surgery.

Dr. Nathaniel Reuter and his colleagues in the Department of Surgery at Louisville concluded,

Surgical resection is associated with a lower chance of recurrence and a longer disease-free interval than RFA and should remain the treatment of choice in resectable hepatic colorectal metastases.

SOURCE: Reuter et al. Journal of Gastrointestinal Surgery, Online First, October 30, 2008.

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