Epidemiology: How to Appraise the Ablation Literature Critically

Abstract

PURPOSE: To evaluate the effectiveness of ablation for hepatic tumors. ablation for hepatic tumors. METHODS: The medical records of patients with either primary or secondary hepatic tumors who underwent ablative procedures from February 1991 to May 2001 at a single institution were retrospectively reviewed. reviewed. One hundred nine patients with tumors ranging in size from 0. tumors ranging in size from 0.5 to 12cm in diameter were treated. in diameter were treated. The diagnoses were colorectal cancer (n = 69), hepatoma (n = 15), ovarian cancer (n = 8), cholangiocarcinoma (n = 4), carcinoid (n = 7), one each of leiomyosarcoma, testicular cancer, and endometrial cancer, and other tumors (n = 3). and other tumors (n = 3). Ablation was used to treat 90 tumors: 47 percutaneously, 23 laparoscopically, and 20 intraoperatively. and 20 intraoperatively. Additional tumors were identified by intraoperative ultrasound in 37% of the patients taken to surgery despite extensive preoperative imaging. despite extensive preoperative imaging. In 45%, radiofrequency ablation (RFA) was combined with resection or cryoablation or both. with resection or cryoablation or both. Alcohol ablation was performed on those patients who were found to have residual tumor after the initial ablative procedure. initial ablative procedure. Ten patients underwent a second procedure and three had a third for progressive or recurrent disease. for progressive or recurrent disease. Neoadjuvant chemotherapy was used in 19 cases, intrahepatic treatment in 10, and postoperative chemotherapy was given to 33 patients. chemotherapy was given to 33 patients. Followup ranged between 12 and 28 months.ranged between 12 and 28 months. RESULTS: If we exclude the six cases in which it was clearly impossible to destroy the liver tumors and the one death due to postprocedure myocardial infarction, median progression-free survival was 13 months. survival was 13 months. Tumor response was seen in 87% of cases. seen in 87% of cases. Median time to death or last follow-up was 18 months: 16 months for nonsurvivors, and 20 months for survivors. nonsurvivors, and 20 months for survivors. Complications occurred in 27% of patients and included one skin burn, one postoperative hemorrhage from hepatic parenchyma cracking, and two hepatic abscesses. Only 4. 7% locally recurred, although 37% have died of their cancer, and another 28% developed metastatic disease at other sites. at other sites. CONCLUSION: Ablation may be effective in allowing patients to undergo liver surgery and achieve better survival. surgery and achieve better survival.