Abstract
Almost 40% of people diagnosed with colorectal cancer will die from their disease, most with metastatic spread. When feasible, hepatic resection offers the greatest probability of cure for isolated liver metastases, but there are barriers to curative resection. Those barriers include the extent and distribution of lesions within the liver, extrahepatic disease, comorbidities, and age. Chemotherapy is often administered before or after resection with the intention of improving disease-free and overall survival. The timing of chemotherapy (adjuvant vs. neoadjuvant vs. perioperative) for patients undergoing potentially curative hepatic resection of metastasis of colorectal cancer origin is controversial. Colorectal cancer patients with liver metastases resected at The Ottawa Hospital between January 1, 2003, and December 31, 2009, were identified, and their clinical records were retrospectively reviewed. Patients receiving intraoperative radiofrequency ablation (rfa) as part of their management were included. Factors associated with overall and disease-free survival were evaluated. The 168 identified patients (57% men, 43% women) had a median age of 63 years (range: 31-84 years). After hepatectomy, 10% had positive resection margins. Intraoperative rfa was used in 25 patients (15%). Chemotherapy was administered in the neoadjuvant (19%), adjuvant (31%), or "perioperative" (both neoadjuvant and adjuvant, 50%) setting. Use or omission of intraoperative rfa was not associated with a difference in overall survival (hazard ratio: 0.99; 95% confidence interval: 0.53 to 1.84; p = 0.97). Compared with patients who did not receive chemotherapy, those who received chemotherapy, regardless of timing, experienced improved overall survival and disease-free survival. Use of rfa where required as an adjunct to hepatic resection appears to be effective and is not associated with worse overall survival.
Highlights
Of the estimated 23,800 Canadians diagnosed with colorectal cancer annually, approximately 9200 (40%) will die from their disease, most with distant metastatic spread[1]
Colorectal cancer patients with liver metastases resected at The Ottawa Hospital between January 1, 2003, and December 31, 2009, were identified, and their clinical records were retrospectively reviewed
Chemotherapy was administered in the neoadjuvant (19%), adjuvant (31%), or “perioperative” setting
Summary
Of the estimated 23,800 Canadians diagnosed with colorectal cancer (crc) annually, approximately 9200 (40%) will die from their disease, most with distant metastatic spread[1]. Hepatic resection offers the greatest probability of cure for patients with isolated liver metastases[2] Even for those with disease that is largely liver-limited, there are barriers to curative resection such as the extent and distribution of lesions within the liver, extrahepatic disease, comorbidities, and age[3]. Hepatic resection offers the greatest probability of cure for isolated liver metastases, but there are barriers to curative resection. Those barriers include the extent and distribution of lesions within the liver, extrahepatic disease, comorbidities, and age. The timing of chemotherapy (adjuvant vs neoadjuvant vs perioperative) for patients undergoing potentially curative hepatic resection of metastasis of colorectal cancer origin is controversial
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