RADIOFREQUENCY ABLATION AS PART OF INTRAHEPATIC TREATMENT STRATEGIES

Abstract

Background. Liver resection remains a gold standard for the treatment of colorectal liver metastases; however, radiofrequency ablation (RFA) may serve as an alternative for patients with contraindications to resection or within parenchymasparing strategies. The aim of this study was to analyze treatment outcomes, prognostic factors, and survival after RFA of intraparenchymal colorectal liver metastases. Materials and Methods. A retrospective analysis was performed on 33 patients with colorectal liver metastases who underwent RFA between 2013 and 2023. The ablation was carried out using the Cool-tip RF Ablation System E Series (Covidien) with a maximum output power of 200 W and internally cooled monopolar needles with a 3 cm active tip, under intraoperative ultrasound guidance. Results. Patients were stratified according to survival status. Group 1 (n = 23) included patients who underwent RFA and were alive at the time of analysis; Group 2 (n = 10) included those who died of disease progression. The survival was significantly influenced by the presence of synchronous metastases (21.7% vs 100.0%, p < 0.001), metachronous metastases (78.3% vs 0, p < 0.001), and median time to progression (18 (78.3%) vs 1 (10.0%), p = 0.0004). No significant effect was found for sex, age, primary tumor localization or morphology, number of chemotherapy lines before ablation, maximal size and number of metastases, type of surgery for the primary tumor, or the presence of comorbidities. Conclusion. RFA in the treatment of colorectal liver metastases is a safe alternative for the unresectable lesions or within parenchyma-sparing strategies. However, liver resection should be considered a priority option when technically feasible. Combining resection and RFA expands the range of patients eligible for radical intervention, potentially improving disease-free and overall survival rates. These findings are limited by baseline group disparities. Randomized or propensity-matched studies are needed to confirm RFA efficacy and define the target population most likely to benefit.