Department of Surgical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
Br J Surg. 2011 Jul;98(7):1003-9. doi: 10.1002/bjs.7506. Epub 2011 May 3.
The results of surgery for recurrent colorectal liver metastases (CLM) after radiofrequency ablation (RFA) have not been evaluated.
From 1993 to 2009, data on patients who underwent resection or RFA for recurrent CLM were collected prospectively. Inclusion criteria for this study were RFA as initial treatment for CLM and resection of recurrent CLM after RFA. Postoperative results and oncological outcomes were analysed.
Twenty-eight patients (median number of tumours 1 (1-3), median size 2·8 (2·0-4·0) cm) met the inclusion criteria. Of these, 22 had recurrence at the site of RFA only, two developed new lesions, whereas four had both recurrent and de novo metastases. At the time of resection, patients had a median of 1 (1-13) CLM with a median maximum tumour diameter of 5·0 (1·8-11·0) cm, significantly larger than at the time of RFA (P = 0·021). Ninety-day postoperative morbidity and mortality rates were 46 per cent (13 of 28) and 7 per cent (2 of 28) respectively. After a median follow-up of 35 (0-70) months, 3-year overall and disease-free survival rates calculated by Kaplan-Meier analysis were 60 and 29 per cent respectively. Plasma carcinoembryonic antigen level over 5 ng/ml at the time of resection and a rectal primary tumour were associated with worse survival (P = 0·041 and P = 0·021 respectively).
Resection for recurrence after RFA is associated with significant morbidity and modest long-term benefit.
射频消融（RFA）后复发性结直肠肝转移（CLM）的手术结果尚未得到评估。
从 1993 年到 2009 年，前瞻性地收集了接受复发性 CLM 切除或 RFA 治疗的数据。本研究的纳入标准为 RFA 作为 CLM 的初始治疗以及 RFA 后复发性 CLM 的切除。分析了术后结果和肿瘤学结果。
28 例患者（肿瘤中位数 1 个（1-3 个），肿瘤中位数大小 2.8cm（2.0-4.0cm））符合纳入标准。其中，22 例仅在 RFA 部位复发，2 例出现新病变，4 例既有复发也有新发病灶。在切除时，患者的 CLM 中位数为 1 个（1-13 个），最大肿瘤直径中位数为 5.0cm（1.8-11.0cm），明显大于 RFA 时（P = 0.021）。90 天术后发病率和死亡率分别为 46%（28 例中的 13 例）和 7%（28 例中的 2 例）。中位随访 35 个月（0-70 个月）后，通过 Kaplan-Meier 分析计算的 3 年总生存率和无病生存率分别为 60%和 29%。切除时的血浆癌胚抗原水平超过 5ng/ml 和直肠原发病灶与生存率较差相关（P = 0.041 和 P = 0.021）。
RFA 后复发的切除术与显著的发病率和适度的长期获益相关。
