Outcome after hepatic resection versus combined resection and microwave ablation for multiple bilobar colorectal metastases to the liver

BACKGROUND: We investigated the efficacy of microwave ablation plus hepatectomy for multiple bilobar colorectal metastases to the liver. No consensus exists concerning local ablation plus hepatic resection for treating multiple bilobar colorectal liver metastases, partly because of a lack of long-term comparative survival data. METHODS: Clinicopathologic data were analyzed retrospectively for 53 consecutive patients with 5 or more bilobar liver metastases from colorectal cancer who underwent hepatectomy with or without microwave ablation. Outcome measures were recurrence rate, recurrence pattern, and survival. RESULTS: Combined resection/ablation was performed more frequently in patients with more liver metastases (P = .03). No significant differences were found for overall, disease-free, or hepatic recurrence-free survival between 16 patients with resection/ablation and 37 patients with resection (P = .43, .54, and .86, respectively). Multivariate analysis selected prehepatectomy carcinoembryonic antigen concentration in serum as an independent prognosticator for survival (P = .02), but not resection/ablation versus resection. In patients with combined resection/ablation, recurrence occurred near the resection or ablation line in only 2 patient (22%), whereas multiple neoplasms (>/=4) was the most common liver recurrence pattern (78%). CONCLUSIONS: Microwave ablation plus hepatic resection expanded indications for operation to treat multiple bilobar liver metastases, with survival similar to that in less-involved hepatic resection patients.