Thermal Ablation for Colorectal Liver Metastases

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  • BEPPU TORU
    Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University
  • HORINO KEI
    Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University
  • KOMORI HIROYUKI
    Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University
  • SUGIYAMA SHINICHI
    Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University
  • MASUDA TOSHIRO
    Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University
  • HAYASHI HIROMITSU
    Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University
  • OKABE HIROHISA
    Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University
  • OHTAO RYU
    Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University
  • IMSEUNG CHOI
    Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University
  • HAYASHI NAOKO
    Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University
  • WATANABE MASAYUKI
    Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University
  • BABA HIDEO
    Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University

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Other Title
  • 大腸癌肝転移の熱凝固療法

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Abstract

Hepatic resection in combination with systemic chemotherapy is a standard treatment modality for colorectal liver metastases (CRLM). Recently, thermal ablation, including microwave coagulation therapy (MCT) and radiofrequency ablation (RFA), has been utilized in the treatment of unresectable and partially resectable CRLM. A review of the English language literature and a summary of our experiences in applying thermal ablation in the treatment of CRLM are described here. RFA is used worldwide, and MCT is primarily utilized in eastern countries. In using percutaneous and laparoscopic/open surgical RFA, local recurrence rates were16% and 4% for tumors < 3 cm, 26% and 22% for tumors between 3-5 cm, and 60% and 50% for tumors > 5 cm. In a large series of treatments which utilized RFA for liver tumors, the mortality and morbidity rates were only 0.3 and 7.2%, respectively. The incidence of tumor seeding after the use of RFA for the treatment of CRLM is as high as 1.4%. Cumulative 5-year survival rates were 29%-36% using MCT and 14%-35% using RFA for unresectable CRLM. Long-term survival data for resectable CRLM are unclear. In our experience, local recurrence rates were undetectable in following the treatment of 30 cases of CRLM (average tumor diameter : 1.7 cm, average observation period : 26 months) which were treated with surgical RFA combined with hepatic resection after efficacious systemic chemotherapy. In Conclusion : 1) thermal ablation can be applied to unresectable CRLM without perivascular invasion, and for tumors < 3 cm with a percutaneous or surgical approach, and for tumors < 5 cm with a surgical approach ; 2) RFA after effective chemotherapy can provide an extremely high local control rate ; and 3) the application of thermal ablation for resectable CRLM is still controversial due to the lack of sufficient evidence obtained from a randomized trial.

Journal

  • Thermal Medicine

    Thermal Medicine 24 (3), 83-89, 2008

    Japanese Society for Thermal Medicine

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