Elias Dominique, Baton Olivier, Sideris Lucas, Matsuhisa Tadashi, Pocard Marc, Lasser Philippe
Division of Surgical Oncology, Department of Surgery, Gustave Roussy Institute, 39 Rue Camille Desmoulins, 94805 Villejuif Cedex, France.
Ann Surg Oncol. 2004 May;11(5):500-5. doi: 10.1245/ASO.2004.08.019. Epub 2004 Apr 12.
The indications and results of intraoperative radiofrequency ablation (RFA) of liver metastases (LMs) are not well defined in the literature and have never been compared with those of hepatectomy. The aim of the study was to appreciate the local recurrence rate of RFA in comparison with anatomic and wedge resection.
Eighty-eight patients with technically unresectable LMs were treated with curative intent. The LMs were treated by anatomic resection (40 patients, 213 LMs) when large, by wedge resection (64 patients, 99 LMs) when peripheral and small, and by RFA (88 patients, 227 LMs) when central and small. The median follow-up was 27.6 months (range, 15-74 months), and a total of 539 LMs were treated (median of 5 per patient).
The local recurrence rates were 5.7% for the 227 RFAs, 7.1% for the 99 wedge resections, and 12.5% for the 40 anatomic resections (P =.216). Local recurrence rates after RFA were correlated with LMs larger than 30 mm (P <.001) and with LMs in direct contact with large vessels (P <.001).
RFA is as efficient and safe as wedge or anatomic resections in terms of local control.
肝转移瘤术中射频消融（RFA）的适应证和结果在文献中尚无明确界定，且从未与肝切除术的相关情况进行比较。本研究的目的是评估与解剖性切除和楔形切除相比，RFA的局部复发率。
88例技术上无法切除的肝转移瘤患者接受了根治性治疗。对于较大的肝转移瘤，采用解剖性切除（40例患者，213个肝转移瘤）；对于周边较小的肝转移瘤，采用楔形切除（64例患者，99个肝转移瘤）；对于中央较小的肝转移瘤，采用RFA（88例患者，227个肝转移瘤）。中位随访时间为27.6个月（范围15 - 74个月），共治疗了539个肝转移瘤（每位患者中位治疗5个）。
227次RFA的局部复发率为5.7%，99次楔形切除的局部复发率为7.1%，40次解剖性切除的局部复发率为12.5%（P = 0.216）。RFA后的局部复发率与直径大于30 mm的肝转移瘤相关（P < 0.001），也与与大血管直接接触的肝转移瘤相关（P < 0.001）。
在局部控制方面，RFA与楔形或解剖性切除一样有效且安全。
