Can stereotactic radiofrequency ablation replace liver resection?
Percutaneous radiofrequency ablation (RFA) is a minimal invasive potentially curative local ablative tumour treatment with very low morbidity and mortality rates as compared to surgery. The question arises whether RFA can replace liver resection. Recent studies have shown that patient long-term survival data after RFA approach the resection data despite inclusion of patients with a poorer prognosis due to comorbidities or disadvantageous tumour distribution. However, since most of the data still favour resection conventional RFA is currently only considered the primary local tumour treatment in combination with surgery or in patients with unresectable colorectal liver metastases (CRLM). Recent improvements in ablation technology and the application of stereotaxy for probe placement have led to local control rates approaching the rates of R0 resections. If stereotactic radiofrequency ablation (SRFA) achieves similar survival rates as compared to resection it may be the method of first choice in patients with potentially resectable colorectal liver metastases. Randomised controlled studies comparing resection and SRFA could finally answer the title question.