Original Articles Radiofrequency Ablation in Patients With Primary and Secondary Hepatic Malignancies V.E. de Meijer, M.Sc., C. Verhoef, M.D., J.W. Kuiper, M.D., I.P.J. Alwayn, M.D., Ph.D., G. Kazemier, M.D., Ph.D., J.N.M. IJzermans, M.D., Ph.D. The aims of this study were to assess the technical effectiveness of radiofrequency (RF) ablation in pa- tients with primary or secondary hepatic malignancies and to determine survival and complication rates. This was a retrospective analysis of prospectively collected data of patients treated with RF ablation and controlled for recurrence every 3 months by contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI). The outcome is compared with a comprehensive review of data published in recent literature. Forty-seven patients underwent 50 RF sessions for the ablation of 73 tumors. Local tu- mor progression was observed in 11 patients (23%). A tumor sized larger than 30 mm, a tumor load larger than 14 cm 3 , and a percutaneous approach were associated with a faster time to local tumor pro- gression. At the end of a mean (6 SD) follow-up period of 11.4 6 7.5 months, 39 patients (83%) were alive, including eight patients with recurrent disease. The overall cumulative survival rates at 12 and 24 months were 87% and 70%, respectively. In our center, RF ablation can be safely performed to achieve adequate local control and survival rates. Time to local tumor progression was significantly related to initial size of the tumor and tumor load. ( J GASTROINTEST SURG 2006;10:960–973) Ó 2006 The Society for Surgery of the Alimentary Tract KEY WORDS: Liver cancer, radiofrequency ablation, local tumor progression Colorectal cancer (CRC) is a major cause of can- cer-related death in Europe. The cumulative lifetime risk in the Western world is approximately 5%, the incidence rate is 50/100,000. Nearly 50% of patients with colorectal carcinoma either have liver metasta- ses at presentation (15%–25%) or will subsequently develop them (20%). 1,2 Without any treatment, the median survival after the detection of liver metasta- ses is less than a year, depending on the extent of the disease at the time of diagnosis. 3,4 In contrast, re- section of liver metastases from colorectal origin is associated with a 5-year survival rate of 30%–50%, depending on the extent of liver involvement and provided that all disease can be removed safely. 4 Un- fortunately, only 10%–25% of patients with colorectal liver metastases are amenable for liver re- section, either because of tumor location, comorbid- ity, or insufficient hepatic reserve. 5,6 Hepatocellular carcinoma (HCC) is the fifth most common cancer in the world and the third most common cause of cancer mortality. 1 In North Amer- ica and in several European countries including the Netherlands, HCC is uncommon, with an incidence rate of less than 5/100,000 and a mortality rate of less than 5/100,000. 1,2 An increase of the incidence in low-endemic areas has been reported for the United Kingdom, France, and the United States. 7–9 In contrast, Verhoef et al. 10 recently did not find any rising trend for the Netherlands. In the last 10 years, screening programs have resulted in a relative increase in the number of resectable cases, and the absolute number of resectable cases has increased as well. Surgical resection is the golden standard of therapy and seems to be the only effective way, aside from liver transplantation, to alter survival. How- ever, due to advanced or decompensated liver Presented at the biannual meeting of the Dutch Society for Surgery, Ede, The Netherlands, November 25, 2005 (oral presentation). From the Departments of Surgery (V.E. de M., I.P.J.A., G.K., J.N.M.I.), Surgical Oncology (C.V.), and Radiology (J.W.K.), Erasmus MC, University Medical Center Rotterdam, The Netherlands. Reprint requests: J.N.M. IJzermans, M.D., Ph.D., Department of Surgery, Erasmus MC – University Medical Center Rotterdam, P. O. Box 2040, 3000 CA Rotterdam, The Netherlands. e-mail: j.ijzermans@erasmusmc.nl 960 Ó 2006 The Society for Surgery of the Alimentary Tract Published by Elsevier Inc. 1091-255X/06/$dsee front matter doi:10.1016/j.gassur.2006.03.003