Percutaneous ablation of post-surgical solitary early recurrence of colorectal liver metastases is an effective "test-of-time" approach.
Luca ViganoJacopo GalvaninDario PorettiDaniele Del FabbroDamiano GentileVittorio PediciniLuigi SolbiatiGuido TorzilliPublished in: Updates in surgery (2021)
Standard treatment of early recurrence of colorectal liver metastases (CLM) after liver resection (LR) is chemotherapy followed by loco-regional therapy. We reviewed the outcome of a different strategy ("test-of-time" approach): upfront percutaneous ablation without chemotherapy. Twenty-six consecutive patients with early solitary liver-only recurrence amenable to both resection and ablation (< 30 mm, distant from vessels) undergone "test-of-time" approach were analyzed. Early recurrence had a median size of 17 mm and occurred after a median interval from LR of 4 months. Primary efficacy rate of ablation was 100%. Five patients are alive and disease-free after a mean follow-up of 46 months. Five patients had local-only recurrence; all had repeat treatment (LR = 4; Ablation = 1) without chemotherapy. Local recurrence risk was associated with incomplete ablation of 1-cm thick peritumoral margin. The remaining 16 patients had non-local recurrence, 13 early after ablation. Overall, six (23%) patients had ablation as unique treatment and 13 (50%) avoided or postponed chemotherapy (mean chemotherapy-free interval 33.5 months). Ablation without chemotherapy of early liver-only recurrence is a reliable "test-of-time" approach. It minimized the invasiveness of treatment with good effectiveness and high salvageability in case of local failure, avoided worthless surgery, and saved chemotherapy for further disease progression.
Keyphrases
- end stage renal disease
- chronic kidney disease
- ejection fraction
- radiofrequency ablation
- free survival
- liver metastases
- locally advanced
- prognostic factors
- randomized controlled trial
- peritoneal dialysis
- stem cells
- minimally invasive
- acute coronary syndrome
- bone marrow
- radiation therapy
- rectal cancer
- lymph node
- mesenchymal stem cells
- cell therapy
- replacement therapy