Radiofrequency Ablation vs. Resection for Hepatic Colorectal Metastasis: Therapeutically Equivalent?
Radiofrequency Ablation vs. Resection for Hepatic Colorectal Metastasis: Therapeutically Equivalent?
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DOI：
10.1007/s11605-008-0727-0
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发表时间：
2009-03-01
影响因子：
3.2
通讯作者：
Martin, Robert C. G.
中科院分区：
文献类型：
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作者：
Reuter, Nathaniel P.;Woodall, Charles E.;Martin, Robert C. G.
随着消融技术的变化和全身化疗的改善，消融治疗肝结直肠转移瘤（HCM）的作用不断发展。我们的目的是评价射频消融术（RFA）与手术切除术相比治疗HCM的疗效。1995年8月至2007年7月的105例前瞻性肝脏数据库确定了192例仅行肝切除或仅行消融治疗HCM的患者。基于相似的Fong评分，接受RFA的患者与切除患者相似（1.8 vs. 2.1 p = 0.28）、存在肝外疾病（15% vs. 9% p = 0.19）、平均肝脏病变数量（2.8 vs. 2.1 p = 0.14）和既往化疗（67% vs. 60% p = 0.33）。消融术的中位复发时间短于切除术（12.2 vs. 31.1个月; p < 0.001）。消融-切除部位的复发比切除更常见，分别为17%和2%（p <0.001）。肝脏远处复发也更常见，消融组33%的患者发生，切除组14%（p = 0.002）。与RFA相比，手术切除术复发的机会更低，无病期更长，应继续作为可切除HCM的治疗选择。
The role of ablation for hepatic colorectal metastases (HCM) continues to evolve as ablation technology changes and systemic chemotherapy improves. Our aim was to evaluate the therapeutic efficacy of radiofrequency ablation (RFA) of HCM compared to surgical resection.A retrospective review of our 1,105 patient prospective hepatic database from August 1995 to July 2007 identified 192 patients with only hepatic resection or only ablation for HCM.Patients who underwent RFA were similar to resection patients based on a similar Fong score (1.8 vs. 2.1 p = 0.28), presence of extrahepatic disease (15% vs. 9% p = 0.19), mean number of hepatic lesions (2.8 vs. 2.1 p = 0.14), and prior chemotherapy (67% vs. 60% p = 0.33). Median time to recurrence was shorter with ablation than resection (12.2 vs. 31.1 months; p < 0.001). Recurrence at the ablation-resection site was more common with ablation than resection occurring 17% vs. 2% (p a parts per thousand currency signaEuro parts per thousand 0.001) of the time, respectively. Distant recurrence in the liver was also more common with ablation occurring in 33% of patients vs. 14% for resection (p = 0.002).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 HCM.