An appraisal of percutaneous treatment of liver metastases

Percutaneous treatments, such as ethanol injection and radiofrequency, have been recently proposed for the treatment of liver metastases. The aim of this study was to evaluate the effects of these treatments in a series of 8 patients who subsequently underwent liver resection. These patients had been treated with percutaneous methods between December 1995 and May 1997. In 6 patients, the primary tumor was colonic; in 2 patients, carcinoid; and in 1 patient, ileal leiomyosarcoma. The lesions were all initially small in size (1.5 to 3.5 cm), single in 7 patients, and multiple in 1 patient with a carcinoid tumor. The initial decision for percutaneous treatment had been made on subjective grounds by the radiologists who originally saw the patients. The number of percutaneous treatment sessions ranged from 2 to 21. In all patients, a progression of the disease occurred. Four patients underwent a right hepatectomy; 1 patient, a left lobectomy; 2 patients, a segmentectomy; and 1 patient, a wedge resection. There was no operative mortality in any of these 8 patients. Two patients presented with seeding of the neoplasm on the diaphragm, which was resected. Histologic examination of all surgical specimens revealed the presence of vital neoplastic tissue; only two specimens of carcinoid tumors showed more than 50% necrosis of the nodules treated percutaneously. These results led us to express doubts as to the efficacy of percutaneous ablative treatment for liver metastases.