Abstract
To explore the effect of portal vein chemotherapy on liver metastasis after surgical resection of colorectal cancer. Patients fulfilling the eligibility criteria were assigned to receive either surgery plus 1-week continuous infusion of 5-FU (study group) or surgery alone (observational group). Patients in the study group received portal vein chemotherapy, whereby 5-FU (1000 mg/d) and heparin (5000 IU/d) infusion was initiated from the day of surgery and lasted for 7 consecutive days. Liver metastasis was monitored during five years follow-up postoperatively. Sixty four patients were recruited and assigned to the study group (12 with colon and 20 with rectal cancer) or the control group (10 with colon and 22 with rectal cancer). Liver metastasis rate was 12.5% in study and 25.0% in observational group, the difference being significant (P<0.01). Portal vein chemotherapy could be an effective treatment in preventing liver metastasis after surgical resection of colorectal cancer.
Highlights
Colorectal cancer is a common cause of morbidity and mortality, and is resectable in approximately three quarters of patients (Ohman et al, 1985; El-Basmy et al, 2012)
Rate of liver metastasis was caculated according to 5 years follow-up data, and compared between two groups by log-rank test, which is 12.5% (4/32) in study and 25% (8/32)in observational group with statistical significance (P
A randomized study inculded 753 colorectal cancer patients receiving either surgery alone, surgery plus postoperative portal vein (PVI) of 5-FU 500 mg/m2 for 24 hours and seven consecutive days given on the first day, or surgery and the same chemotherapy regimen administered by peripheral venous route suggested that 5-year disease-free survival were 65%, 60% (PVI, hazard ratio 1.18, p=0.23), and 64%; the 5-year overall survival was 72%, 69% (PVI, hazard ratio 1.21, p=0.2), and 74%, respectively (Laffer et al, 2008)
Summary
Colorectal cancer is a common cause of morbidity and mortality, and is resectable in approximately three quarters of patients (Ohman et al, 1985; El-Basmy et al, 2012). Effective adjuvant treatment is essential to prevent liver metastasis. Many efforts have been attempted in this setting, adjuvant portal venous chemotherapy is an option to prevent the development of colorectal liver metastasis with some encouraging results (Taylor et al, 1979). In a trial on 244 patients, initiated in 1975, they reported, after a median followup of 50 months, a statistically significant improvement in survival in patients treated with 5-FU portal vein chemotherapy (1000 mg/day, with heparin infused continuously for the first 7 postoperative days) compared to patients receiving surgery alone. PVI led to a modest but statistically significant improvement in survival, even after exclusion of the promising initial trial on this therapeutic approach (RR=0.89; 95% Cl 0.84 to 0.94)
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