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Commentary: Radiofrequency ablation for colorectal liver metastases: do not blame the biology when it is the technology

2008; Elsevier BV; Volume: 197; Issue: 6 Linguagem: Inglês

10.1016/j.amjsurg.2008.06.029

1879-1883

Eddie K. Abdalla,

Cholangiocarcinoma and Gallbladder Cancer Studies

In this issue of The American Journal of Surgery, Hur et al 1 Hur H. Ko Y.T. Min B.S. et al. Comparative study of resection and radiofrequency ablation in the treatment of solitary colorectal metastases. Am J Surg. 2009; 197: 728-736 Abstract Full Text Full Text PDF PubMed Scopus (190) Google Scholar present their experience with surgical treatment of patients with solitary colorectal liver metastasis (CLM). They analyzed 67 patients treated by hepatic resection (HR, 42 patients) or by radiofrequency ablation (RF, 25 patients, including 12 treated percutaneously and 13 intraoperatively) and reiterated the established superior 5-year overall and recurrence-free survival observed after HR compared with RF (hazard ratio for death after treatment by RF was 2.65 vs HR; hazard ratio for local recurrence after treatment with RF was 4.61 compared with HR; both P < .03 on multivariate analysis). In a small subset of patients with tumors that were 3 cm or less in diameter (23 HR patients and 15 RF patients), outcomes were better, but a 4-fold higher local recurrence rate for RF versus HR was found (the lack of statistical significance of this large difference in this subset likely was a result of a type II error). This report highlights critical areas worthy of further discussion: the importance of the treatment selection for patients with CLM and the influence of tumor biology versus ablation technology (or its application) on local treatment efficacy and outcome.