U. Waqar1, A. Arif1, M. Arshad1, M. Nawaz1, M. Ali1, T. Chawla1,2 1Aga Khan University Medical College, Medical College, Karachi, Sindh, Pakistan 2Aga Khan University Hospital, Department Of Surgery, Karachi, SINDH, Pakistan
Introduction:
Concomitant intraoperative ablation combined with liver resection (LR) has emerged as a safe strategy for managing colorectal liver metastases (CRLMs), exhibiting superior outcomes when contrasted with resection alone. This study endeavors to compare postoperative outcomes in individuals undergoing concurrent microwave ablation (MWA) vs. radiofrequency ablation (RFA) during LR for CRLMs.
Methods:
Utilizing the ACS-NSQIP targeted hepatectomy database, we identified patients who underwent elective LR accompanied by either MWA or RFA for CRLMs from 2014 through 2021. Patients with fewer than two metastases or those with other ablation types were excluded. Our primary outcome centered on optimal LR attainment, defined as the absence of mortality, severe morbidity, the necessity for postoperative invasive procedures or reoperations, extended hospital stays, and readmissions within 30 days post-surgery. Propensity score matching was performed based on age, gender, American Society of Anesthesiologists physical status, receipt of neoadjuvant therapy, operative approach, LR extent, tumor diameter, and metastasis count. Subsequent multivariable binary logistic regression models were employed to evaluate the relationship between ablation type and postoperative outcomes.
Results:
This study included 687 patients after propensity score matching. Most patients were male (N=407; 59.2%), presented with 3-5 metastases (N=456; 66.4%), had tumors with a maximum diameter ranging from 2-5 cm (N=324; 47.2%), and underwent minor LR procedures (N=570; 83.0%). A total of 385 patients (56.0%) received MWA, while 302 (44.0%) underwent RFA. The two cohorts were generally similar in demographic and perioperative characteristics, except for a higher proportion of MWA patients requiring the Pringle maneuver during surgery (30.4% MWA vs. 17.9% RFA; p <0.001). Of the total, 461 patients (67.1%) achieved optimal LR, whereas 84 patients (12.2%) experienced severe morbidity. Regression analyses showed no significant differences in the rates of achieving optimal LR (OR 0.998, 95% CI 0.692-1.438), major morbidity (OR 1.157, 95% CI 0.679-1.970), overall morbidity (OR 1.249, 95% CI 0.773-2.018), or perioperative transfusion (OR 1.136, 95% CI 0.663-1.945) with MWA vs. RFA. We further conducted subgroup regression analyses based on resection extent, metastatic lesion diameters, and metastatic lesion counts. For patients receiving MWA vs. RFA, no significant differences in achieving optimal LR were observed across all subgroups (Table 1).
Conclusion:
In this nationwide propensity-matched analysis encompassing patients undergoing LR with intraoperative ablation for CRLMs, our findings indicate comparable safety profiles between MWA and RFA.
