Serum procalcitonin is induced as part of the SIRS after ILP with rhTNF-alpha/melphalan. It may be induced directly by rhTNF-alpha or other cytokines, because serum peaks of IL-6 and IL-8 precede the peak of PCT. Because there is no correlation between serum levels of PCT and hemodynamic variables, this marker cannot be applied to assess the severity of SIRS reaction after ILP.

For patients with liver metastases, surgery currently represents the only possibility for cure, with a mean 5-year survival rate of 25-35%. Due to refinement in operative and anesthetic techniques and improved critical care with decreased morbidity (< 25%) and mortality (< 5%), hepatic resection is a safe and efficient procedure. Surgery has repeatedly achieved long-term disease-free survival in 20-25% of patients. However, only 10-25% of patients with colorectal liver metastases can undergo potentially curative liver resection. Therefore, accurate staging plays a pivotal role in selecting patients who would benefit from surgery. For metastatic colorectal cancer, resection offers the only potential for cure. For symptomatic neuroendocrine tumors, hepatic resection offers long-term palliation in many cases and cure in some. The role of hepatic resection for noncolorectal and nonneuroendocrine metastases, however, is less well defined. Recurrence of hepatic metastases after seemingly curative resection is observed in about 40-60% of the cases. Only 20-35% of these recurrent metastases appear to be resectable, resulting in an overall 3-year survival rate of about 30%. The morbidity and mortality from repeat hepatectomy is similar to that of first hepatic resection. All results together demonstrate that resection and re-resection of liver metastases can provide long-term survival rates and can be beneficial in a carefully selected group of patients without extrahepatic disease.

For patients with colorectal liver metastases, surgery offers the only possibility for cure. The achievable mean 5-year survival rate is 30%, and the 5-year disease-free survival rate approximately 15%. Due to refinement in operative and anesthetic techniques, improved critical care with a decrease in morbidity (< 30%) and mortality (< 5%), hepatic resection is a safe and efficient procedure. However, only 10–15% of patients with colorectal liver metastases can undergo potentially curative liver resection. Therefore, accurate staging is an important prerequisite in selecting patients who would benefit from surgery. Today, the most generally accepted contraindication for liver resection is the presence of discontinuous extra-hepatic spread and more than 4 metastases. Recurrence of hepatic metastases after potentially curative resection is observed in over 50% of cases. Re-resection of recurrent liver metastases can be beneficial in a carefully selected group of patients with limited disease. Multimodal neoadjuvant therapy is a promising tool for patients with colorectal liver metastases initially considered not R0-resectable. Cryosurgery and laser-induced thermotherapy are additive methods that may help to improve surgical treatment results in the future. Improvement in clinical outcome and survival can be achieved.

No abstract