Liver resection comes with a morbidity of 30% of which a third is serious, Clavien > 3b, and a length of hospital stay of 7-10 days, somewhat less after a lap approach. Of these at least 30% will have a liver recurrence within five years.
With crlm now treated more as a chronic disease is it not better to use a minimal invasive and liver sparing approach when percutaneous or laparoscopic, fusion guided, ire or microwave ablation can be performed with a local recurrence rate under 10%, morbidity in the range of 10% and length of stay of 0-1 days? (lesions
Dear Dr Freedman,
I agree with you and would be interested to pool our results... In addition, I would like to refer to an extensive similar discussion on researchgate which was stimulated by Dr Julianov a few weeks ago. However I do not know how to technically link to the QA within researchgate...
Dr Freedman, congratulations for performing this analysis, which I believe can change our practice.
Until now best results are achieve with hepatic resection, sparing the most liver as you can. As you know in liver surgery more important than what you take is what you spare, so mostly of the colorectal liver metastases under 3 cm won't be a problem because remaining liver function will be enough.
For now ablation techniques are a good option in high risk patients and in central metastases hard to resect. It appears that microwave ablation is better than radio frequency, and some authors say microwave ablation will be the future. Will it? Don't know. I will wait for your results.
Best
Carlos
Dear Dr Freedman,
Your question is as old as the ablation techniques are.
However its background is also important. You mentioned that the current severe complication rate of resection of CRLM is as high as 10% (Clavien grade >3b). Another interesting point in your question is that 5-year recurrence rate after ablation of CRLM is
Dear Dr Julianov, I have had access to the livermetsurvey database for a poster in IHPBA this year where I went through all resections for a single metastasis
Dear Dr. Freedman,
thank you for sharing these data! Your data demonstrate that if you use a method within the limits you will produce good results.
Thanks for sharing. However all those publications lacks strength of high-grade evidence. I can recommend as the state of the art analysis the paper below:
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0051510/pdf/TOC.pdf
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