Skip to main content
PMC home page
Springer Nature - PMC COVID-19 Collection logoLink to Springer Nature - PMC COVID-19 Collection
. 2003;10(9):1059–1069. doi: 10.1245/ASO.2003.03.026

Combined Resection and Radiofrequency Ablation for Advanced Hepatic Malignancies: Results in 172 Patients

Timothy M Pawlik 1, Francesco Izzo 3, Deborah S Cohen 2, Jeffery S Morris 2, Steven A Curley 1,4,✉
PMCID: PMC7101740  PMID: 14597445

Abstract

Background: Resection combined with radiofrequency ablation (RFA) is a novel approach in patients who are otherwise unresectable. The objective of this study was to investigate the safety and efficacy of hepatic resection combined with RFA.

Methods: Patients with multifocal hepatic malignancies were treated with surgical resection combined with RFA. All patients were followed prospectively to assess complications, treatment response, and recurrence.

Results: Seven hundred thirty seven tumors in 172 patients were treated (124 with colorectal metastases; 48 with noncolorectal metastases). RFA was used to treat 350 tumors. Combined modality treatment was well tolerated with low operative times and minimal blood loss. The postoperative complication rate was 19.8% with a mortality rate of 2.3%. At a median follow-up of 21.3 months, tumors had recurred in 98 patients (56.9%). Failure at the RFA site was uncommon (2.3%). A combined total number of tumors treated with resection and RFA >10 was associated with a faster time to recurrence (P = .02). The median actuarial survival time was 45.5 months. Patients with noncolorectal metastases and those with less operative blood loss had an improved survival (P = .03 and P = .04, respectively), whereas radiofrequency ablating a lesion >3 cm adversely impacted survival (HR = 1.85, P = .04).

Conclusions: Resection combined with RFA provides a surgical option to a group of patients with liver metastases who traditionally are unresectable, and may increase long-term survival.

Key Words: Hepatocellular cancer, Liver metastases, Resection, Radiofrequency ablation

REFERENCES

  • 1.Di Bisceglie A, Rustgi V, Hoffnagle J, Dusheiko GM, Lotze MT. NIH conference on hepatocellular carcinoma. Ann Intern Med. 1988;108:390–401. doi: 10.7326/0003-4819-108-3-390. [DOI] [PubMed] [Google Scholar]
  • 2.Weiss L, Grundmann E, Torhorst J, et al. Hematogenous metastatic patterns in colonic carcinoma: an analysis of 1541 necropsies. J Pathol. 1986;150:195–203. doi: 10.1002/path.1711500308. [DOI] [PubMed] [Google Scholar]
  • 3.Fong Y, Cohen AM, Fortner JG, et al. Liver resection for colorectal metastases. J Clin Oncol. 1997;15:938–946. doi: 10.1200/JCO.1997.15.3.938. [DOI] [PubMed] [Google Scholar]
  • 4.Blumgart LH, Fong Y. Surgical options in the treatment of hepatic metastases from colorectal cancer. Curr Probl Surg. 1995;32:333–421. doi: 10.1016/S0011-3840(05)80012-7. [DOI] [PubMed] [Google Scholar]
  • 5.Tuttle TM. Hepatectomy for noncolorectal liver metastases. In: Curley SA, editor. Liver Cancer. New York:: Springer-Verlag Publishers;; 1998. pp. 201–211. [Google Scholar]
  • 6.Liver Cancer Study Group of Japan. Primary liver cancer in Japan: clinicopathologic features and results of surgical treatment. Ann Surg. 1990;211:277–284. [PMC free article] [PubMed] [Google Scholar]
  • 7.Nagorney DM, van Heerden JA, Ilstrup DM, Adson MA. Primary hepatic malignancy: surgical management and determinants of survival. Surgery. 1989;106:740–748. [PubMed] [Google Scholar]
  • 8.Rhim H, Dodd GD., III Radiofrequency thermal ablation of liver tumors. J Clin Ultrasound. 1999;27:221–229. doi: 10.1002/(SICI)1097-0096(199906)27:5<221::AID-JCU1>3.0.CO;2-T. [DOI] [PubMed] [Google Scholar]
  • 9.Curley SA, Izzo F, Delrio P, et al. Radiofrequency ablation of unresectable primary and metastatic hepatic malignancies: results in 123 patients. Ann Surg. 1999;230:1–8. doi: 10.1097/00000658-199907000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Wood TF, Rose DM, Chung M, Allegra DP, Foshag LJ, Bilchik AJ. Radiofrequency ablation of 231 unresectable hepatic tumors: indications, limitations, and complications. Ann Surg Oncol. 2000;7:593–600. doi: 10.1007/BF02725339. [DOI] [PubMed] [Google Scholar]
  • 11.de Baere T, Elias D, Dromain C, et al. Radiofrequency ablation of 100 hepatic metastases with a mean follow up of more than 1 year. Am J Roentgenol. 2000;175:1619–1625. doi: 10.2214/ajr.175.6.1751619. [DOI] [PubMed] [Google Scholar]
  • 12.Solbiati L, Ierace T, Tonolino M, Orti V, Cova L. Radiofrequency thermal ablation of hepatic metastases. Eur J Ultrasound. 2001;13:149–158. doi: 10.1016/S0929-8266(01)00127-6. [DOI] [PubMed] [Google Scholar]
  • 13.Bilchik AJ, Wood TF, Allegra DP. Radiofrequency ablation of unresectable hepatic malignancies: lessons learned. Oncologist. 2001;6:24–33. doi: 10.1634/theoncologist.6-1-24. [DOI] [PubMed] [Google Scholar]
  • 14.Vogl T, Mack M, Straub R. Thermal ablation of liver metastases. Current status and prospects. Radiologe. 2001;41:49–55. doi: 10.1007/s001170050926. [DOI] [PubMed] [Google Scholar]
  • 15.Curley SA, Cusack JC, Tanabe KK, Stoelzing O, Ellis LM. Advances in the treatment of liver tumors. Curr Probl Surg. 2002;39:449–571. doi: 10.1067/msg.2002.122810. [DOI] [PubMed] [Google Scholar]
  • 16.Pearson AS, Izzo F, Fleming RY, et al. Intraoperative radiofrequency ablation or cryoablation for hepatic malignancies. Am J Surg. 1999;178:592–598. doi: 10.1016/S0002-9610(99)00234-2. [DOI] [PubMed] [Google Scholar]
  • 17.Curley SA, Izzo F, Ellis LM, Vauthey J, Vallone P. Radiofrequency ablation of hepatocellular cancer in 110 patients with cirrhosis. Ann Surg. 2000;232:381–391. doi: 10.1097/00000658-200009000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18.Stangl R, Altendorf-Hofmann A, Charnley RM. Factors influencing the natural history of colorectal liver metastases. Lancet. 1994;343:1405–1410. doi: 10.1016/S0140-6736(94)92529-1. [DOI] [PubMed] [Google Scholar]
  • 19.Ruers T, Bleichrodt RP. Treatment of liver metastases, an update on the possibilities and results. Eur J Cancer. 2002;38:1023–1033. doi: 10.1016/S0959-8049(02)00059-X. [DOI] [PubMed] [Google Scholar]
  • 20.Steele G, Ravikumar T. Resection of hepatic metastases from colorectal cancer. Biologic perspective. Ann Surg. 1989;210:127–138. doi: 10.1097/00000658-198908000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Adson MA, van Heerden JA, Adson MH, Wagner JS, Ilstrup DM. Resection of hepatic metastases from colorectal cancer. Arch Surg. 1984;119:647–651. doi: 10.1001/archsurg.1984.01390180015003. [DOI] [PubMed] [Google Scholar]
  • 22.Zuro LM, Staren ED. Cryosurgical ablation of unresectable hepatic tumors. AORN-J. 1996;64:231–244. doi: 10.1016/s0001-2092(06)63151-7. [DOI] [PubMed] [Google Scholar]
  • 23.Tandan VR, Harmantas A, Gallinger S. Long-term survival after hepatic cryosurgery versus surgical resection for metastatic colorectal carcinoma: a critical review of the literature. Can J Surg. 1997;40:175–181. [PMC free article] [PubMed] [Google Scholar]
  • 24.Ishii H, Okada S, Nose H, et al. Local recurrence of hepatocellular carcinoma after percutaneous ethanol injection. Cancer. 1996;77:1792–1796. doi: 10.1002/(SICI)1097-0142(19960501)77:9<1792::AID-CNCR6>3.0.CO;2-E. [DOI] [PubMed] [Google Scholar]
  • 25.Liviraghi T, Bolondi L, Lazzaroni S, et al. Percutaneous ethanol injection in the treatment of hepatocellular carcinoma in cirrhosis. A study on 207 patients. Cancer. 1992;69:925–929. doi: 10.1002/1097-0142(19920215)69:4<925::AID-CNCR2820690415>3.0.CO;2-G. [DOI] [PubMed] [Google Scholar]
  • 26.MaGahan JP, Schneider P, Brock JM. Treatment of liver tumors by percutaneous radiofrequency electrocautery. Semin Interven Radiol. 1993;10:143–149. doi: 10.1055/s-2008-1074717. [DOI] [Google Scholar]
  • 27.Rossi S, Di Stasi M, Buscarini E, et al. Percutaneous radiofrequency interstitial thermal ablation in the treatment of small hepatocellular carcinoma. Cancer J Sci Am. 1995;1:73–81. [PubMed] [Google Scholar]
  • 28.Ebra M. Percutaneous ethanol injection for the treatment of hepatocellular carcinoma: study of 95 patients. Gastroenterol Hepatol. 1990;15:615–626. doi: 10.1111/j.1440-1746.1990.tb01115.x. [DOI] [PubMed] [Google Scholar]
  • 29.Lencioni R, Pinto F, Armillotta N, et al. Long-term results of percutaneous ethanol injection therapy for hepatocellular in cirrhosis: a European experience. Eur Radiol. 1997;7:514–519. doi: 10.1007/s003300050194. [DOI] [PubMed] [Google Scholar]
  • 30.Riley DK, Babinchak TJ, Zemel R, Weaver ML, Rotheram EB. Infection complications of hepatic cryosurgery. Clin Infect Dis. 1997;24:1001–1003. doi: 10.1093/clinids/24.5.1001. [DOI] [PubMed] [Google Scholar]
  • 31.Adam R, Akpinar E, Johann M, Kunstlinger F, Majno P, Bismuth H. Place of cryosurgery in the treatment of malignant liver tumors. Ann Surg. 1997;225:38–39. doi: 10.1097/00000658-199701000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32.Korpan NN. Hepatic cryosurgery for liver metastases: long-term follow-up. Ann Surg. 1997;225:193–201. doi: 10.1097/00000658-199702000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33.Yeh KA, Fortunato L, Hoffman JP, Eisenberg BL. Cryosurgical ablation of hepatic metastases from colorectal carcinomas. Ann Surg. 1997;63:63–68. [PubMed] [Google Scholar]
  • 34.Rossi S, Di Stasi M, Buscarini E, et al. Percutaneous RF interstitial thermal ablation in the treatment of hepatic cancer. Am J Roentgenol. 1996;167:759–768. doi: 10.2214/ajr.167.3.8751696. [DOI] [PubMed] [Google Scholar]
  • 35.Solbiati L, Goldberg SN, Ierace T, et al. Hepatic metastasis: percutaneous radio-frequency ablation with cooled-tip electrodes. Radiology. 1997;205:367–373. doi: 10.1148/radiology.205.2.9356616. [DOI] [PubMed] [Google Scholar]
  • 36.Dodd GD, III, Soulen MC, Kane RA, et al. Minimally invasive treatment of malignant hepatic tumors: at the threshold of a major breakthrough. Radio Graphics. 2000;20:9–27. doi: 10.1148/radiographics.20.1.g00ja019. [DOI] [PubMed] [Google Scholar]
  • 37.Goldberg SN, Gazelle GS, Solbiati L, Rittman WJ, Mueller PR. Radiofrequency tissue ablation: increased lesion diameter with a perfusion electrode. Acad Radiol. 1996;3:636–644. doi: 10.1016/S1076-6332(96)80443-0. [DOI] [PubMed] [Google Scholar]
  • 38.Gillams A, Lees WR. Image guided ablation of colorectal liver metastases: time for a randomized controlled trial versus hepatic resection. Radiology. 1999;213P:212. [Google Scholar]
  • 39.Gillams A. Thermal ablation of liver metastases. Abdominal Imaging. 2001;26:361–368. doi: 10.1007/s002610000196. [DOI] [PubMed] [Google Scholar]
  • 40.Bleicher RJ, Allegra DP, Nora DT, Wood TF, Foshag LJ, Bilchik AJ. Radiofrequency ablation in 447 complex unresectable liver tumors: lessons learned. Ann Surg Oncol. 2003;10:52–58. doi: 10.1245/ASO.2003.03.018. [DOI] [PubMed] [Google Scholar]
  • 41.Elias D, Goharin A, El Otmany A, et al. Usefulness of intraoperative radiofrequency thermoablation of liver tumors associated or not with hepatectomy. Eur J Surg Oncol. 2000;26:763–769. doi: 10.1053/ejso.2000.1000. [DOI] [PubMed] [Google Scholar]
  • 42.Que FG, Nagorney DM, Batts KP, Linz LJ, Kvols LK. Hepatic resection for metastatic neuroendocrine carcinomas. Am J Surg. 1995;169:36–43. doi: 10.1016/S0002-9610(99)80107-X. [DOI] [PubMed] [Google Scholar]
  • 43.Carty SE, Jensen RT, Norton JA. Prospective study of aggressive resection of metastatic pancreatic endocrine tumors. Surgery. 1992;112:1024–1032. [PubMed] [Google Scholar]
  • 44.Berber E, Flesher N, Siperstein AE. Laparoscopic radiofrequency ablation of neuroendocrine liver metastases. World J Surg. 2002;26:985–990. doi: 10.1007/s00268-002-6629-5. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgical Oncology are provided here courtesy of Nature Publishing Group

RESOURCES