The local efficacy of microwave ablation versus surgical resection for subcapsular colorectal liver metastases.

INTRODUCTION

The effectiveness of microwave ablation (MWA) versus surgical resection (SR) for subcapsular colorectal liver metastases (CRLM) is debated, with limited clinical evidence. This study examines the local therapeutic efficacy and complications of MWA and SR for treating subcapsular CRLM.

MATERIALS AND

METHODS

Between January 2013 and December 2020, 519 patients with subcapsular CRLM were retrospectively included. This research was conducted on 768 subcapsular CRLM (621 in the MWA group and 147 in the SR group). Propensity score matching (PSM) with a ratio of 1:2 and adjusted Cox proportional hazards regression were utilized to balance the potential bias between the two groups. Local tumor progression (LTP) rate and complication rate were compared between the two groups.

RESULTS

After PSM, 363 CRLM were matched: 232 in the MWA group and 131 in the SR group. Before PSM, LTP was 13.5% and 16.3% for MWA and SR groups; after PSM, it was 18.9% and 15.2% for MWA and SR groups. No significant difference in LTPFS between the groups (multivariable analysis, p = 0.395; PSM analysis, p = 0.374). Multivariable analysis identified protrusion as a significant factor for poor LTPFS in the MWA group. In the protruding CRLM subgroup, SR resulted in superior LTPFS compared to MWA (p = 0.037). The MWA group had a significantly lower minor and major complication rate than the SR group (both p < 0.001).

CONCLUSION

Compared with SR, MWA provides comparable local tumor control and lower complication rates for subcapsular CRLM. SR is preferable for protruding CRLM.