A prospective multicentre trial on survival after Microwave Ablation VErsus Resection for Resectable Colorectal liver metastases (MAVERRIC)

Pascale Tinguely; Simeon J S Ruiter; Jennie Engstrand; Robbert J de Haas; Henrik Nilsson; Daniel Candinas; Koert P de Jong; Jacob Freedman

doi:10.1016/j.ejca.2023.03.038

A prospective multicentre trial on survival after Microwave Ablation VErsus Resection for Resectable Colorectal liver metastases (MAVERRIC)

Eur J Cancer. 2023 Jul:187:65-76. doi: 10.1016/j.ejca.2023.03.038. Epub 2023 Apr 5.

Authors

Pascale Tinguely¹, Simeon J S Ruiter², Jennie Engstrand³, Robbert J de Haas⁴, Henrik Nilsson⁵, Daniel Candinas⁶, Koert P de Jong², Jacob Freedman⁵

Affiliations

¹ Division of Surgery, Department of Clinical Sciences, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden; Department of Visceral Surgery and Medicine, Inselspital, University Hospital Bern, Bern, Switzerland; ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland. Electronic address: pascale.tinguely@ki.se.
² Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
³ Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
⁴ Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
⁵ Division of Surgery, Department of Clinical Sciences, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden.
⁶ Department of Visceral Surgery and Medicine, Inselspital, University Hospital Bern, Bern, Switzerland.

PMID: 37119639
DOI: 10.1016/j.ejca.2023.03.038

Abstract

Aim: This multi-centre prospective cohort study aimed to investigate non-inferiority in patients' overall survival when treating potentially resectable colorectal cancer liver metastasis (CRLM) with stereotactic microwave ablation (SMWA) as opposed to hepatic resection (HR).

Methods: Patients with no more than 5 CRLM no larger than 30 mm, deemed eligible for both SMWA and hepatic resection at the local multidisciplinary team meetings, were deliberately treated with SMWA (study group). The contemporary control group consisted of patients with no more than 5 CRLM, none larger than 30 mm, treated with HR, extracted from a prospectively maintained nationwide Swedish database. After propensity-score matching, 3-year overall survival (OS) was compared as the primary outcome using Kaplan-Meier and Cox regression analyses.

Results: All patients in the study group (n = 98) were matched to 158 patients from the control group (mean standardised difference in baseline covariates = 0.077). OS rates at 3 years were 78% (Confidence interval [CI] 68-85%) after SMWA versus 76% (CI 69-82%) after HR (stratified Log-rank test p = 0.861). Estimated 5-year OS rates were 56% (CI 45-66%) versus 58% (CI 50-66%). The adjusted hazard ratio for treatment type was 1.020 (CI 0.689-1.510). Overall and major complications were lower after SMWA (percentage decrease 67% and 80%, p < 0.01). Hepatic retreatments were more frequent after SMWA (percentage increase 78%, p < 0.01).

Conclusion: SMWA is a valid curative-intent treatment alternative to surgical resection for small resectable CRLM. It represents an attractive option in terms of treatment-related morbidity with potentially wider options regarding hepatic retreatments over the future course of disease.

Keywords: Ablation techniques; Colorectal neoplasm; Hepatectomy; Liver; Neoplasm metastasis; Stereotaxic techniques; Survival analysis.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Colonic Neoplasms* / surgery
Colorectal Neoplasms* / pathology
Hepatectomy
Humans
Liver Neoplasms* / secondary
Microwaves / therapeutic use
Prospective Studies
Retrospective Studies