Solitary colorectal liver metastasis: Resection determines outcome

Thomas A. Aloia, Jean Nicolas Vauthey, Evelyne M. Loyer, Dario Ribero, Timothy M. Pawlik, Steven H. Wei, Steven A. Curley, Daria Zorzi, Eddie K. Abdalla, David M. Nagorney, Merril T. Dayton, Philip D. Schneider, Anton J. Bilchik, Kelly M. McMasters, William C. Chapman

Research output: Contribution to journalArticle

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Abstract

Background: Hepatic resection (HR) and radiofrequency ablation (RFA) have been proposed as equivalent treatments for colorectal liver metastasis. Hypothesis: Recurrence patterns after HR and RFA for solitary liver metastasis are similar. Design: Analysis of a prospective database at a tertiary care center with systematic review of follow-up imaging in all of the patients. Patients and Methods: Patients with solitary liver metastasis as the first site of metastasis treated for cure by HR or RFA were studied (patients received no prior liver-directed therapy). Prognostic factors, recurrence patterns, and survival rates were analyzed. Results: Of the 180 patients who were studied, 150 underwent HR and 30 underwent RFA. Radiofrequency ablation was used when resection would leave an inadequate liver remnant (20 patients) or comorbidity precluded safe HR (10 patients). Tumor size and treatment determined recurrence and survival. The local recurrence (LR) rate was markedly lower afterHR(5%) than after RFA (37%) (P<.001). Treatment by HR was associated with longer 5-year survival rates than RFA, including LR-free (92% vs 60%, respectively; P<.001), disease-free (50% vs 0%, respectively; P=.001), and overall (71% vs 27%, respectively; P<.001) survival rates. In the subset with tumors 3 cm or larger (n=79), LR occurred more frequently following RFA (31%) than after HR (3%) (P=.001), with a 5-year LR-free survival rate of 66% after RFA vs 97% after HR (P<.001). Patients with small tumors experienced longer 5-year overall survival rates after HR (72%) as compared with RFA (18%) (P=.006). Conclusions: The survival rate following HR of solitary colorectal liver metastasis exceeds 70% at 5 years. Radiofrequency ablation for solitary metastasis is associated with a markedly higher LR rate and shorter recurrence-free and overall survival rates compared with HR, even when small lesions (≤3 cm) are considered. Every method should be considered to achieve resection of solitary colorectal liver metastasis, including referral to a specialty center, extended hepatectomy, and chemotherapy.

Original languageEnglish (US)
Pages (from-to)460-467
Number of pages8
JournalArchives of Surgery
Volume141
Issue number5
DOIs
StatePublished - May 2006

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Neoplasm Metastasis
Liver
Recurrence
Survival Rate
Neoplasms
Hepatectomy
Therapeutics
Tertiary Care Centers
Comorbidity
Referral and Consultation
Databases
Drug Therapy

ASJC Scopus subject areas

  • Surgery

Cite this

Aloia, T. A., Vauthey, J. N., Loyer, E. M., Ribero, D., Pawlik, T. M., Wei, S. H., ... Chapman, W. C. (2006). Solitary colorectal liver metastasis: Resection determines outcome. Archives of Surgery, 141(5), 460-467. https://doi.org/10.1001/archsurg.141.5.460

Solitary colorectal liver metastasis : Resection determines outcome. / Aloia, Thomas A.; Vauthey, Jean Nicolas; Loyer, Evelyne M.; Ribero, Dario; Pawlik, Timothy M.; Wei, Steven H.; Curley, Steven A.; Zorzi, Daria; Abdalla, Eddie K.; Nagorney, David M.; Dayton, Merril T.; Schneider, Philip D.; Bilchik, Anton J.; McMasters, Kelly M.; Chapman, William C.

In: Archives of Surgery, Vol. 141, No. 5, 05.2006, p. 460-467.

Research output: Contribution to journalArticle

Aloia, TA, Vauthey, JN, Loyer, EM, Ribero, D, Pawlik, TM, Wei, SH, Curley, SA, Zorzi, D, Abdalla, EK, Nagorney, DM, Dayton, MT, Schneider, PD, Bilchik, AJ, McMasters, KM & Chapman, WC 2006, 'Solitary colorectal liver metastasis: Resection determines outcome', Archives of Surgery, vol. 141, no. 5, pp. 460-467. https://doi.org/10.1001/archsurg.141.5.460
Aloia TA, Vauthey JN, Loyer EM, Ribero D, Pawlik TM, Wei SH et al. Solitary colorectal liver metastasis: Resection determines outcome. Archives of Surgery. 2006 May;141(5):460-467. https://doi.org/10.1001/archsurg.141.5.460
Aloia, Thomas A. ; Vauthey, Jean Nicolas ; Loyer, Evelyne M. ; Ribero, Dario ; Pawlik, Timothy M. ; Wei, Steven H. ; Curley, Steven A. ; Zorzi, Daria ; Abdalla, Eddie K. ; Nagorney, David M. ; Dayton, Merril T. ; Schneider, Philip D. ; Bilchik, Anton J. ; McMasters, Kelly M. ; Chapman, William C. / Solitary colorectal liver metastasis : Resection determines outcome. In: Archives of Surgery. 2006 ; Vol. 141, No. 5. pp. 460-467.
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title = "Solitary colorectal liver metastasis: Resection determines outcome",
abstract = "Background: Hepatic resection (HR) and radiofrequency ablation (RFA) have been proposed as equivalent treatments for colorectal liver metastasis. Hypothesis: Recurrence patterns after HR and RFA for solitary liver metastasis are similar. Design: Analysis of a prospective database at a tertiary care center with systematic review of follow-up imaging in all of the patients. Patients and Methods: Patients with solitary liver metastasis as the first site of metastasis treated for cure by HR or RFA were studied (patients received no prior liver-directed therapy). Prognostic factors, recurrence patterns, and survival rates were analyzed. Results: Of the 180 patients who were studied, 150 underwent HR and 30 underwent RFA. Radiofrequency ablation was used when resection would leave an inadequate liver remnant (20 patients) or comorbidity precluded safe HR (10 patients). Tumor size and treatment determined recurrence and survival. The local recurrence (LR) rate was markedly lower afterHR(5{\%}) than after RFA (37{\%}) (P<.001). Treatment by HR was associated with longer 5-year survival rates than RFA, including LR-free (92{\%} vs 60{\%}, respectively; P<.001), disease-free (50{\%} vs 0{\%}, respectively; P=.001), and overall (71{\%} vs 27{\%}, respectively; P<.001) survival rates. In the subset with tumors 3 cm or larger (n=79), LR occurred more frequently following RFA (31{\%}) than after HR (3{\%}) (P=.001), with a 5-year LR-free survival rate of 66{\%} after RFA vs 97{\%} after HR (P<.001). Patients with small tumors experienced longer 5-year overall survival rates after HR (72{\%}) as compared with RFA (18{\%}) (P=.006). Conclusions: The survival rate following HR of solitary colorectal liver metastasis exceeds 70{\%} at 5 years. Radiofrequency ablation for solitary metastasis is associated with a markedly higher LR rate and shorter recurrence-free and overall survival rates compared with HR, even when small lesions (≤3 cm) are considered. Every method should be considered to achieve resection of solitary colorectal liver metastasis, including referral to a specialty center, extended hepatectomy, and chemotherapy.",
author = "Aloia, {Thomas A.} and Vauthey, {Jean Nicolas} and Loyer, {Evelyne M.} and Dario Ribero and Pawlik, {Timothy M.} and Wei, {Steven H.} and Curley, {Steven A.} and Daria Zorzi and Abdalla, {Eddie K.} and Nagorney, {David M.} and Dayton, {Merril T.} and Schneider, {Philip D.} and Bilchik, {Anton J.} and McMasters, {Kelly M.} and Chapman, {William C.}",
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doi = "10.1001/archsurg.141.5.460",
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T1 - Solitary colorectal liver metastasis

T2 - Resection determines outcome

AU - Aloia, Thomas A.

AU - Vauthey, Jean Nicolas

AU - Loyer, Evelyne M.

AU - Ribero, Dario

AU - Pawlik, Timothy M.

AU - Wei, Steven H.

AU - Curley, Steven A.

AU - Zorzi, Daria

AU - Abdalla, Eddie K.

AU - Nagorney, David M.

AU - Dayton, Merril T.

AU - Schneider, Philip D.

AU - Bilchik, Anton J.

AU - McMasters, Kelly M.

AU - Chapman, William C.

PY - 2006/5

Y1 - 2006/5

N2 - Background: Hepatic resection (HR) and radiofrequency ablation (RFA) have been proposed as equivalent treatments for colorectal liver metastasis. Hypothesis: Recurrence patterns after HR and RFA for solitary liver metastasis are similar. Design: Analysis of a prospective database at a tertiary care center with systematic review of follow-up imaging in all of the patients. Patients and Methods: Patients with solitary liver metastasis as the first site of metastasis treated for cure by HR or RFA were studied (patients received no prior liver-directed therapy). Prognostic factors, recurrence patterns, and survival rates were analyzed. Results: Of the 180 patients who were studied, 150 underwent HR and 30 underwent RFA. Radiofrequency ablation was used when resection would leave an inadequate liver remnant (20 patients) or comorbidity precluded safe HR (10 patients). Tumor size and treatment determined recurrence and survival. The local recurrence (LR) rate was markedly lower afterHR(5%) than after RFA (37%) (P<.001). Treatment by HR was associated with longer 5-year survival rates than RFA, including LR-free (92% vs 60%, respectively; P<.001), disease-free (50% vs 0%, respectively; P=.001), and overall (71% vs 27%, respectively; P<.001) survival rates. In the subset with tumors 3 cm or larger (n=79), LR occurred more frequently following RFA (31%) than after HR (3%) (P=.001), with a 5-year LR-free survival rate of 66% after RFA vs 97% after HR (P<.001). Patients with small tumors experienced longer 5-year overall survival rates after HR (72%) as compared with RFA (18%) (P=.006). Conclusions: The survival rate following HR of solitary colorectal liver metastasis exceeds 70% at 5 years. Radiofrequency ablation for solitary metastasis is associated with a markedly higher LR rate and shorter recurrence-free and overall survival rates compared with HR, even when small lesions (≤3 cm) are considered. Every method should be considered to achieve resection of solitary colorectal liver metastasis, including referral to a specialty center, extended hepatectomy, and chemotherapy.

AB - Background: Hepatic resection (HR) and radiofrequency ablation (RFA) have been proposed as equivalent treatments for colorectal liver metastasis. Hypothesis: Recurrence patterns after HR and RFA for solitary liver metastasis are similar. Design: Analysis of a prospective database at a tertiary care center with systematic review of follow-up imaging in all of the patients. Patients and Methods: Patients with solitary liver metastasis as the first site of metastasis treated for cure by HR or RFA were studied (patients received no prior liver-directed therapy). Prognostic factors, recurrence patterns, and survival rates were analyzed. Results: Of the 180 patients who were studied, 150 underwent HR and 30 underwent RFA. Radiofrequency ablation was used when resection would leave an inadequate liver remnant (20 patients) or comorbidity precluded safe HR (10 patients). Tumor size and treatment determined recurrence and survival. The local recurrence (LR) rate was markedly lower afterHR(5%) than after RFA (37%) (P<.001). Treatment by HR was associated with longer 5-year survival rates than RFA, including LR-free (92% vs 60%, respectively; P<.001), disease-free (50% vs 0%, respectively; P=.001), and overall (71% vs 27%, respectively; P<.001) survival rates. In the subset with tumors 3 cm or larger (n=79), LR occurred more frequently following RFA (31%) than after HR (3%) (P=.001), with a 5-year LR-free survival rate of 66% after RFA vs 97% after HR (P<.001). Patients with small tumors experienced longer 5-year overall survival rates after HR (72%) as compared with RFA (18%) (P=.006). Conclusions: The survival rate following HR of solitary colorectal liver metastasis exceeds 70% at 5 years. Radiofrequency ablation for solitary metastasis is associated with a markedly higher LR rate and shorter recurrence-free and overall survival rates compared with HR, even when small lesions (≤3 cm) are considered. Every method should be considered to achieve resection of solitary colorectal liver metastasis, including referral to a specialty center, extended hepatectomy, and chemotherapy.

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