Hepatic resection was shown to be superior to radiofrequency ablation (RFA) for the treatment of colorectal liver metastases, according to a model used to stimulate a randomized controlled trial. Researchers from the Hepatobiliary and Pancreatic Surgery Program at the Providence Portland Medical Center in Oregon used Markov modeling to analyze data from 30 articles culled from a systematic literature search, with additional data for the RFA arm obtained from a prospective database of more than 900 patients considered for liver surgery there.
“The model produced a 5-year overall survival of 38.2% after hepatic resection vs 27.2% for RFA, and the 5-year disease-free survival was 29.8% after resection vs 15.5% after RFA,” the authors reported in the Archives of Surgery. “Based on the existing published data, our decision analysis demonstrates that hepatic resection remains the preferred strategy for the treatment of [colorectal liver metastases]. However, at present RFA is primarily used for the treatment of patients with unresectable [liver metastases] or advanced disease, introducing significant bias into the comparison of outcomes of RFA vs hepatic resection. Markov modeling demonstrates that RFA can provide outcomes equivalent to those of hepatic resection if the median disease-free survival following RFA can be improved.”
Using sensitivity analysis, the researchers found that RFA “becomes a better strategy if the median disease-free survival after treatment is at least 1.42 years, which is lower than the median disease-free survival for hepatic resection (1.56 years) from the pooled data.” In addition, they noted, “when input was limited to laparoscopic RFA of resectable colorectal liver metastases performed at our institution, the quality-adjusted life expectancy after ablation was found to be superior to that after hepatic resection” and “the overall survival was better at all time points.”
The authors acknowledge that these results “will need to be reproduced at other institutions, and randomized controlled trials will be required before more widespread use of RFA becomes acceptable.”