Long-term Outcomes Following Tumor Ablation for Treatment of Bilateral Colorectal Liver Metastases

IMPORTANCE Ablative therapies extend the capability of delivering potentially curative treatment for bilateral hepatic colorectal metastases. OBJECTIVE To compare the long-term effectiveness of ablation with that of resection in patients with bilateral hepatic colorectal metastases. DESIGN Review of a prospective database of 2123 operative cases of hepatic colorectal metastases. SETTING A large institution with expertise in ablation and resection. PATIENTS Patients with bilateral colorectal liver metastases undergoing operation with a curative intent. A total of 141 patients had been treated with bilateral resection (BR) and 95 had undergone ablation. INTERVENTIONS Radiofrequency or microwave ablation alone or in combination with resection (A/R) compared with BR. MAIN OUTCOMES AND MEASURES We compared tumor characteristics and operative and postoperative outcomes using chi(2) or Wilcoxon tests as appropriate and assessed overall survival differences between the 2 groups using the log-rank test. RESULTS During the study, 141 patients were treated with BR and 95 patients with A/R. The A/R group was a significantly poorer prognostic group than the BR group as judged by the Clinical Risk Score (P < .01). There was no difference in median operative time (A/R: 280 minutes, BR: 282 minutes; P = .52), but a lower blood loss (A/R: 300 mL, BR: 500 mL; P < .01) and a shorter length of stay (A/R: 7 days, BR: 9 days; P < .01) was achieved in the A/R group. Long-term outcome was not significantly different between the groups (5-year overall survival, A/R: 56%, BR: 49%; P = .16). CONCLUSIONS AND RELEVANCE Treatment of bilateral, multiple hepatic metastases with combined resection and ablation was associated with improved perioperative outcomes without compromising long-term survival compared with bilateral resection. Ablative therapies extend the capability of delivering potentially curative treatment for bilateral hepatic colorectal metastases.