ORIGINAL ARTICLE – GASTROINTESTINAL ONCOLOGY
Combined Thermal–Surgical Ablation of Locally Advanced
Csaba Gajdos, MD
, Tracey MacDermott, BS
, Martin D. McCarter, MD
, and Nathan W. Pearlman, MD
Department of Surgery, GITES Division, University of Colorado at Denver, Denver, CO;
Background. Treatment options for patients with inoper-
able primary or recurrent/metastatic abdominopelvic
malignancies are limited, and these patients have short
lifespan. The purpose of our study is to examine outcomes
of combined open radiofrequency ablation (RFA) and
surgical debulking of otherwise unresectable tumors.
Methods. Consecutive 50 patients were identiﬁed from an
Institutional Review Board (IRB)-approved database
undergoing ablation for unresectable abdominopelvic
malignancies via conventional surgical methods in a single
institution between 07/2003 and 09/2009. Patients were
selected for debulking if they had a dominant mass that
caused signiﬁcant symptoms.
Results. Sixteen patients had primary tumors, and 34
presented with a recurrent/metastatic malignancy. The
primary tumors were abdominopelvic sarcomas (eight
patients), large desmoids (two), colorectal cancer (CRC)
(two), and gastric cancer, mucinous cystic pancreatic
neoplasm, gastrointestinal stromal tumor (GIST), and car-
cinoid (one each). The recurrent/metastatic tumors were
CRCs (16 patients), abdominopelvic sarcomas (12), and
GIST, prostate cancer, bladder cancer, melanoma, adrenal
cancer, and pseudomyxoma peritonei recurrences (1 each).
Twenty-two patients were alive and 28 died as of Sep-
tember 2009. Median survival for patients who died was
9.5 months and for patients who were alive was 22 months.
Patients with primary tumors had 5-year survival of 18%
compared with no survivors at 5 years in the recurrent/
metastatic group (P = 0.002).
Conclusions. Thermosurgical ablation of otherwise unre-
sectable primary tumors and recurrent/metastatic
abdominopelvic malignancies is feasible in selected cases.
Patients with ablated primary tumors have a survival
advantage over patients who have ablation for recurrent/
Curative resection of abdominal and pelvic solid tumors
generally entails en bloc removal of the mass and a margin
of normal tissue. This approach can be problematic when
the normal margin is the aorta, vertebrae, proximal sacrum,
sacroiliac joint or entire pelvis. The same can be true for
lesions covered in multiple fragile blood vessels originat-
ing from all surrounding structures. Extended resections
can occasionally be performed in these settings, but long-
term beneﬁts are generally quite limited. Most patients
with such tumors are considered incurable and treated as
Thermal ablation with radiofrequency electric current,
and more recently microwave energy, has been increas-
ingly used in the past two decades to treat unresectable
tumors in various sites, primarily liver.
In this approach,
one or several probes are placed into the lesion from the
periphery, and the extent of thermal damage is monitored
by real-time ultrasound. Ablated tissue is left in situ.
Control of lesions over 5 cm has proven difﬁcult with this
technique, however, and led to abscesses and/or ﬁstulae
when used for extrahepatic tumors.
ablation alone is unlikely to control the bulky and/or
complex tumors described above.
Radiofrequency ablation coagulates tissue to a greater
depth than would be possible with standard electrosurgery.
In 2003, we initiated a study to determine if radiofrequency
ablation could be combined with surgical debulking to
improve the results of each modality alone. Our hypothesis
was that stepwise removal of ablated tissue would allow
more effective placement of the probe in the depths of the
tumor than if it were left intact, decrease damage to adja-
cent tissue, and reduce chances
Ó Society of Surgical Oncology 2010
First Received: 27 April 2010;
Published Online: 21 December 2010
C. Gajdos, MD
Ann Surg Oncol (2011) 18:1267–1273