Hepatic artery infusion in surgical therapy of hepatic metastases from colorectal cancer

Abstract

15077 Background: The gold standard in the treatment of liver metastases from colorectal cancer (CRC) is surgical resection. Unfortunately most of the patients are unresectable. The purpose of the study was to assess the role of hepatic arterial infusion in the management of these patients. Methods: Our clinical series included 274 patients with liver metastases from CRC (period 1978–2001). One hundred thirty four pts were treated surgically as follows: resection (87 pts), hepatic artery infusion (HAI) (30 pts), resection plus HAI (13 pts), and ablation plus HAI (8 pts). The remaining 139 pts received systemic therapy treatment. A separate (historic) group had supportive care only (historic) group had supportive care only (historic control). Overall and median survival was measured by Kaplan-Meier method from treatment of liver metastases in the surgical group and from diagnosis in systemic therapy/historic groups. Conclusion: A multi-option strategy is essential in surgical planning for management of liver metastases from CRC. Resection has an overall 5 year survival of 25% which is greatly enhanced by addition of adjuvant therapy with HAI. In the event of non-resectability, HAI with tumor ablation or HAI alone is associated with a median survival of 29 and 17 months respectively and provides excellent palliation ensuring that the operative procedure is maximized in these high-risk metastases and may extend survival in patients with non-resectable metastases who are failing systemic chemotherapy. Group Pts. N Surgical Intent 2 yr 5 yr Median (mo) Resection only 87 Curative 73% 25% 35 Resection & HAI 13 Curative 66% 55% Not reached HAI 30 Palliative 23% 0% 17 Ablation plus HAI 8 Palliative 57% 12.5% 29 Systemic Therapy 139 Palliative 13% 1% 11 Historic Controls 136 Supportive 8% 0% 6 No significant financial relationships to disclose.