Ultrasound-guided radiofrequency ablation (RFA) for inoperable gastrointestinal liver metastases

Surgery is the most effective treatment for liver metastases. Some patients, however, cannot tolerate this procedure due to co-morbidity, advanced age, site of the lesion or previous liver surgery. In our institution we have now increasing experience with radiofrequency ablation (RFA), a thermo-ablative modality. We compare our outcome and survival results to standard treatments for liver metastases.

From April 2000 to June 2005, 30 consecutive patients with liver metastases from gastrointestinal primaries were treated with ultrasound guided RFA for their liver metastases (patients mean age 63.5 years, range 37-80. Size of lesions, range 0.4-6 cm). Main indications were non-operable lesions due to site of the lesion or co-morbidity. RFA was also applied as an additive to liver surgery and as a repetitive palliative treatment. 15 patients underwent one RFA-intervention, 8 patients two, 3 patients three, 1 patient four, 2 patients five and 1 patient six. RFA-interventions (n = 60) were performed either percutaneously (71.5%), in an open approach without liver surgery (22%) or in addition to liver surgery (6.5%).

Mean observation time after first RFA was 23.5 months (range 3-63). Median survival in our patient cohort is 34 months, which compares favourably with results obtained by hepatic resection, the standard of care for liver metastases. Complication rate, attributed to the RFA procedure, was small in our series (5.5%) with one pleural effusion and one abscess formation in the ablated lesion due to underlying bacteraemia.

RFA is an effective and low risk treatment modality in patients with liver metastases. The procedure is safe (complication rate < 6%) with low morbidity. RFA can be performed repeatedly on an outpatient basis with good palliative effects. Of note, surgery remains the treatment of choice in resectable liver metastases of colorectal origin.