To compare the clinical efficacy of hepatectomy and microwave ablation (MWA) for colorectal cancer liver metastases (CRLM) and clarify the clinical value and limitations of MWA in high-risk CRLM lesions.
Approach:
Study Design: Retrospective analysis of 98 patients with CRLM treated between July 2008 and February 2019, comparing outcomes between 31 patients who underwent hepatectomy and 67 who received MWA.
Subgroup Analysis: 105 CRLM lesions were categorized into high-risk (n = 36) and non-high-risk (n = 69) locations for further analysis.
Key Findings:
Patients treated with hepatectomy achieved significantly better recurrence-free survival (RFS) and overall survival (OS) than those treated with MWA.
In the MWA cohort, lesions <3 cm in diameter could be completely ablated regardless of anatomical location.
For tumors >3 cm, the complete ablation rate was significantly lower in high-risk lesions than in non-high-risk lesions.
Tumor diameter was identified as an independent risk factor for incomplete ablation.
Interpretation:
The findings suggest that while MWA may be effective for smaller lesions, its efficacy diminishes for larger and high-risk tumors. The superior outcomes associated with hepatectomy highlight the importance of surgical intervention in managing CRLM, particularly for larger tumors where MWA may not achieve complete ablation. This underscores the need for careful patient selection and consideration of tumor characteristics when choosing between these treatment modalities.
Limitations:
The study is retrospective, which may introduce selection bias.
The sample size for the hepatectomy group was relatively small.
Conclusion:
Hepatectomy is more effective than MWA for CRLM, especially for high-risk lesions larger than 3 cm. ---
