Chemotherapy in patients with a solitary colorectal liver metastasis - A nationwide propensity score matched study.

INTRODUCTION: Chemotherapy is widely used as an adjunct to surgery in the treatment of patients with resectable colorectal liver metastases. The aim of this study was to examine whether chemotherapy confers a survival benefit in patients with a solitary colorectal liver metastasis. METHODS: All consecutive patients between 2009 and 2017 in Sweden who were resected for a solitary colorectal liver metastasis were included. Patients treated with chemotherapy were compared with patients who had surgery alone. Unmatched and propensity score matched analyses were performed to compare overall survival, morbidity and mortality. RESULTS: Of 1224 eligible patients, 641 (52.4%) patients had chemotherapy, and 583 (47.6%) had surgery alone. After propensity score matching, two balanced groups with 102 patients in each, were analyzed. There was no difference in readmission within 30-days (p = 0.250), or morbidity, defined as Clavien-Dindo 3a or greater, between the groups (p = 0.761). There were no mortalities within ninety days. Radical resection margins were achieved in 92 (n = 94) per cent in the chemotherapy group, and 77 (n = 78) per cent in the surgery alone group (p = 0.016). Median overall survival was 91 (95% CI 73-109) months in the chemotherapy group, and 78 (95% CI 37-119) months in the surgery-alone group (p = 0.652). CONCLUSION: This nationwide register-based study showed no difference in overall survival between patients treated with chemotherapy compared to surgery alone. Upfront surgery may be advisable in resectable solitary colorectal liver metastasis.

Single-center nonrandomized clinical trial to assess the safety and efficacy of irreversible electroporation (IRE) ablation of liver tumors in humans: Short to mid-term results.

INTRODUCTION: A single-center nonrandomized clinical trial was performed to assess the safety and efficacy of IRE ablation of liver tumors in humans. METHODS: 38 malignant liver tumors on 30 patients were treated with IRE between September 2011 and September 2014. Treatment was with curative intent, and the diagnoses were colorectal cancer with liver metastases (CRLM) (n = 23), hepatocellular carcinoma (HCC) (n = 8) and other metastasis (n = 7). Patients were selected when surgery, radiofrequency ablation (RFA) or microwave ablation (MWA) was not an option, and when they met inclusion criteria (tumor size < 3 cm, 1-2 tumors). Patients were followed-up at 1 and 6 months with a contrast-enhanced computed tomography (CE-CT), and contrast-enhanced ultrasound (CE-US) at 3 months. RESULTS: Ablation success was defined as no evidence of residual tumor in the ablated area as confirmed by CE-CT and CE-US. At 3 months ablation success was 78.9%, and 65.8% at 6 months. There was no statistically significant difference between tumor volume (<5 cm3 vs >5 cm3, p = 0.518), and between diagnosis (CRLM vs HCC, p = 0.084) in terms of local recurrence. Complications were classified according to the standardized grading system of Society of Interventional Radiology (SIR). A minor complication occurred in six patients (20%), one patient (3.3%) suffered from a major complication (bile duct dilatation and stricture of the portal vein and bile duct). No mortalities occurred at 30 days. CONCLUSIONS: IRE appears to be a safe treatment modality for a selected group of patients with liver tumors and offers high local tumor control at 3 and 6 months.