Hepatic metastases from colorectal cancer: Resection or not

Greenway, B

doi:10.1002/bjs.1800750605

Cited by 98 publications

(27 citation statements)

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“…The indications for liver resection for colorectal metastases are still controversial [ 1, 2,11,12]. Authors who started to perform liver resection in the early 1950s only report on very well selected cases with more than threefourths of their patients having symptomatic, but solitary lesions.…”

Section: Discussionmentioning

confidence: 99%

Tumor recurrence and options for further treatment after resection of liver metastases in patients with colorectal cancer

Hohenberger

Schlag

Schwarz

et al. 1990

Journal of Surgical Oncology

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The aim of this study was to evaluate the pattern of recurrence and its impact on therapy in patients undergoing liver resection for colorectal metastases. Within 7 years 105 patients were operated on; 75 patients were followed up for at least 2 years postoperatively with a median follow-up of 30 months (range 24-93 months). The median time interval when patients were free of tumor recurrence was only 9 months. The initial recurrence site was the liver in 47% and the other sites were extrahepatic in 39%. Seventy-one percent of the patients developed disseminated metastases as the disease progressed. The median survival time after diagnosis of tumor recurrence was 14 months and was significantly affected by the type of treatment used for the recurrence. Surgical resection was followed by a 23-month median survival, while systemic and intra-arterial chemotherapy led to a 14- and 15-month median survival time, respectively. Untreated patients had a median survival of only 4 months. It is concluded that liver resection for colorectal secondaries leads to a very limited number of disease-free survivors after 5 years. As a few patients may profit from a surgical treatment even in cases of recurrence, surgery should not be regarded as useless.

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Section: Discussionmentioning

confidence: 99%

Tumor recurrence and options for further treatment after resection of liver metastases in patients with colorectal cancer

Hohenberger

Schlag

Schwarz

et al. 1990

Journal of Surgical Oncology

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“…Five-year survival rates of up to 35% have been reported for patients amenable for partial hepatic resection (Hughes, 1986;Scheele, 1990;Van Ooyen, 1992;Sugihara, 1993;Que, 1994). Unfortunately, the vast majority of colorectal metastases confined to the liver are considered to be unresectable (Greenway, 1988;Cady, 1991;Genari, 1992). In addition, systemic chemotherapy has so far failed to provide satisfactory results in these cases (Kemeny, 1983(Kemeny, , 1987.…”

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confidence: 99%

Isolated hepatic perfusion in the pig with TNF-alpha with and without melphalan

Rinkes

Vries²,

Jonker³

et al. 1997

Br J Cancer

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Summary Isolated limb perfusion with tumour necrosis factor alpha (TNF-a) and melphalan is well tolerated and highly effective in irresectable sarcoma and melanoma. No data are available on isolated hepatic perfusion (IHP) with these drugs for irresectable hepatic malignancies. This study was undertaken to assess the feasibility of such an approach by analysing hepatic and systemic toxicity of IHP with TNF-a with and without melphalan in pigs. Ten healthy pigs underwent IHP. After vascular isolation of the liver, inflow catheters were placed in the hepatic artery and portal vein, and an outflow catheter was placed in the inferior vena cava (IVC). An extracorporeal veno-venous bypass was used to shunt blood from the lower body and intestines to the heart. The liver was perfused for 60 min with (1) 50 ,ug kg-' TNF-ca (n = 5), (2) 50 9g kg-' TNF-a plus 1 mg kg-' melphalan (n = 3) or (3) no drugs (n = 2). The liver was washed with macrodex before restoring vascular continuity. All but one pigs tolerated the procedure well. Stable perfusion was achieved in all animals with median perfusate TNF-a levels of 5.1 ± 0.78 x 106 pg ml-(± s.e.m). Systemic leakage of TNF-a from the perfusate was consistently < 0.02%. Following IHP, a transient elevation of systemic TNF-a levels was observed in groups 1 and 2 with a median peak level of 23 ± 3 x 103 pg ml-' at 10 min after washout, which normalized within 6 h. No significant systemic toxicity was observed. Mild transient hepatotoxicity was seen to a similar extent in all animals, including controls. IHP with TNF-a with(out) melphalan in pigs is technically feasible, results in minimal systemic drug exposure and causes minor transient disturbances of liver biochemistry and histology.Keywords: isolation; liver; perfusion; metastases; tumour necrosis factor The liver is the commonest site of dissemination in patients with colorectal cancer (Bengmark, 1969;Wagner, 1984;Strangl, 1994). Five-year survival rates of up to 35% have been reported for patients amenable for partial hepatic resection (Hughes, 1986;Scheele, 1990; Van Ooyen, 1992;Sugihara, 1993;Que, 1994). Unfortunately, the vast majority of colorectal metastases confined to the liver are considered to be unresectable (Greenway, 1988;Cady, 1991;Genari, 1992). In addition, systemic chemotherapy has so far failed to provide satisfactory results in these cases (Kemeny, 1983(Kemeny, , 1987. Therefore, it is mandatory to develop novel strategies to obtain tumour control in the liver.The concept of locoregional administration of chemotherapy is aimed at achieving high local concentrations while minimizing systemic drug levels in an attempt to reduce dose-limiting sideeffects. This might enhance anti-tumour efficacy as steep dose-response curves have been described for most chemotherapeutic agents (Frei, 1980;Canellos, 1987). Several techniques have been developed for regional therapy of hepatic malignancies, of which hepatic artery infusion (HAI) has become most widely used (Sullivan, 1964;Pentecost, 1993;De Takats, 1994 (Kemeny, ...

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“…Although such favorable results from surgical treatment have provided the rationale for resection of liver metastases, at least 75% of patients still develop recurrence within 5 years of the initial hepatectomy [4]. Indeed, some investigators have reported that repeated hepatectomy for recurrent liver metastases may be efficacious [5]. …”

Section: Introductionmentioning

confidence: 99%

Relationship between Doubling Time of Liver Metastases from Colorectal Carcinoma and Residual Primary Cancer

et al. 1998

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Background: The doubling times of liver metastases were calculated in order to clarify their usefulness in predicting the presence of residual cancer in the abdominal cavity in patients who had undergone curative resection of primary colorectal cancer. Patients and Methods: Tumor doubling times were calculated retrospectively in 22 patients by serial measurement of the size of their liver metastases. Results: Patients with a tumor doubling time of less than 92.4 days had a significantly poorer prognosis than those with a doubling time more than or equal to 92.4 days (p < 0.05). Local recurrence or peritoneal dissemination was significantly more likely to occur when the tumor doubling time was less than 92.4 days than when it was more than or equal to 92.4 days (p < 0.01). Conclusion: The doubling time of hepatic metastases in patients with colorectal carcinoma may be a useful prognostic indicator, with patients who have a shorter tumor doubling time carrying a greater risk of residual primary cancer in the abdominal cavity.

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Hepatic metastases from colorectal cancer: Resection or not

Abstract: This review evaluates the available evidence dealing with the natural history of hepatic metastases in patients with colorectal cancer. Methods of detection of such metastases are discussed and the factors influencing survival after surgical resection are reviewed.

Cited by 98 publications

References 30 publications

Tumor recurrence and options for further treatment after resection of liver metastases in patients with colorectal cancer

Tumor recurrence and options for further treatment after resection of liver metastases in patients with colorectal cancer

Isolated hepatic perfusion in the pig with TNF-alpha with and without melphalan

Relationship between Doubling Time of Liver Metastases from Colorectal Carcinoma and Residual Primary Cancer

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