Effects of Surgery and Palliative Chemotherapy in the Treatment of Colorectal Liver Metastasis

Nigel Bird, Ruth Bird, Ali Majeed

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DOI: 10.4236/ss.2011.26066                

Abstract

Purpose: 1) To compare the survival of patients with colorectal liver metastases who underwent resection as the primary treatment against patients who had chemotherapy as the primary treatment. 2) To compare the survival in patients with recurrent inoperable liver metastases (after resection) treated with Oxaliplatin or Irinotecan against those patients with inoperable recurrence who were treated with 5-FU. Patients and Methods: 538 patients with colorectal liver metastases were referred to our unit between November 1997 and May 2005; 247 underwent liver resection and 291 had palliative chemotherapy. Results: Only 7.8% of non-operated patients survived for 5 years compared to 31.5% of the liver resection group. After surgery, 191 patients developed inoperable recurrent disease. These patients were treated with chemotherapy; Ox/Ir patients had a 3 year survival of 55% compared to 32% of those who received 5-FU. Our data shows that in patients who relapse after liver surgery, chemotherapy with Oxaliplatin or Irinotecan confers a significant survival benefit.

Keywords

Colorectal Cancer, Liver Metastasis, Surgery, Survival, Chemotherapy

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	G. D. Leonard, B. Brenner, N. E. Kemeny “Neoadjuvant Therapy for Patients with Unresectable Liver Metastases from Colorectal Carcinoma,” Journal of Clinical Oncology, Vol. 23, No. 9, pp. 2038-2048. Hdoi:10.1200/JCO.2005.00.349
[2]	E. K. Abdalla, J.-N. Vauthey, L.M. Ellis, et al., “Recurrence and Outcomes Following Hepatic Resection, Radiofrequency Ablation and Combined Resection/Ablation for Colorectal Liver Metastases,” Annals of Surgery, Vol. 239, No. 6, 2004, pp. 818-827. Hdoi:10.1097/01.sla.0000128305.90650.71
[3]	R. Adam, V. Delvart, G. Pascal, et al., “Rescue Surgery for Unresectable Colorectal Liver Metastases Downstaged by Chemotherapy,” Annals of Surgery, Vol. 240, No. 4, 2004, pp. 644-658.
[4]	G. Poston, “Surgical Strategies for Colorectal Liver Metastases,” Surgical Oncology, Vol. 13, No. 2-3, 2004, pp. 125-136. Hdoi:10.1016/j.suronc.2004.08.001
[5]	R. Adam, E. Avisar, S. Giachetti, et al., “Five-Year Survival Following Hepatic Resection after Neoadjuvant Therapy for Nonresectable Colorectal Liver Metastases,” Annals of Surgical Oncology, Vol. 8, No. 4, 2001, pp. 347-353. Hdoi:10.1007/s10434-001-0347-3
[6]	J. S. Wagner, M. A. Adson, J. A. van Heerden, et al., “The Natural History of Hepatic Metastases from Colorectal Cancer. A Comparison with Resective Treatment,” Annals of Surgery, Vol. 199, No. 5, 1984, pp. 502-508. Hdoi:10.1097/00000658-198405000-00002
[7]	J. Scheele, R. Stangl, A. Altenorf-Hofmann, et al., “Indicators of Prognosis after Hepatic Resection for Colorectal Secondaries,” Surgery, Vol. 110, No. 1, 1991, pp. 13-29.
[8]	S. Zakharia, J. H. Donohue, F. G. Que, et al., “Hepatic Resection for Colorectal Liver Metastases,” Annals of Surgery, Vol. 246, No. 2, 2007, pp. 184-191.
[9]	M. A. Choti, J. V. Sitzmann, M. F. Tiburi, et al., “Trends in Long-Term Survival Following Liver Resection for Hepatic Colorectal Liver Metastases,” Annals of Surgery, Vol. 235, No. 6, 2002, pp. 759-766. Hdoi:10.1097/00000658-200206000-00002
[10]	D. Lawes, I. Taylor “Chemotherapy for Colorectal Cancer—An Overview of Current Management for Surgeons,” European Journal of Surgical Oncology, Vol. 31, No. 9, 2005, pp. 932-941. Hdoi:10.1016/j.ejso.2005.03.015
[11]	J. Y. Douillard, D. Cunningham, A. M. Roth, et al., “Irinotecan Combined with Fluorouracil Compared with Fluorouracil Alone as First-Line Treatment for Metastatic Colorectal Cancer: A Multicentre Randomised Trial,” The Lancet, Vol. 355, No. 9209, 2000, pp. 1041-1047. Hdoi:10.1016/S0140-6736(00)02034-1
[12]	L. B. Saltz, J. V. Cox, C. Blanke, et al., “Irinotecan PLUS FLUORouracil and Leucovorin for Metastatic Colorectal Cancer,” The New England Journal of Medicine, Vol. 343, No. 13, 2000, pp. 904-914. Hdoi:10.1056/NEJM200009283431302
[13]	Advanced Colorectal Cancer Meta-analysis Project, “Modulation of Fluorouracil by Leucovorin in Patients with Advanced Colorectal Cancer: Evidence in Terms of Response Rate,” Journal of Clinical Oncology, Vol. 10, No. 6, 1992, pp. 896-903.
[14]	N. J. Petrelli, “Perioperative or Adjuvant Therapy for Resectable Colorectal Hepatic Metastases,” Journal of Clinical Oncology, Vol. 26, No. 30, 2008, pp. 4862-4863. Hdoi:10.1200/JCO.2008.18.5868
[15]	A. W. Majeed and C. Price, “Resource and Manpower Calculations for the Provision of Hepatobiliary Surgical Services in the UK,” Annals of The Royal College of Surgeons of England, Vol. 86, No. 2, 2004, pp. 91-95. Hdoi:10.1308/003588404322827455
[16]	Colorectal Cancer Collaborative Group, “Palliative chemotherapy for Advanced Colorectal Cancer: Systematic Review and Meta-analysis,” British Medical Journal, Vol. 321, No. 7260, 2000, pp. 531-535. Hdoi:10.1136/bmj.321.7260.531
[17]	W.-S. Lee, S. H. Yun, H.-K. Chun, et al., “Pulmonary Resection for Metastases from Colorectal Cancer: Prognostic Factors and Survival,” International Journal of Colorectal Disease, Vol. 22, No. 6, 2006, pp. 699-704.
[18]	T. Sakamoto, N. Tsubota, K. Iwanaga, et al., “Pulmonary Resection for Metastases from Colorectal Cancer,” Chest, Vol. 119, No. 4, 2001, pp. 1069-1072. Hdoi:10.1378/chest.119.4.1069
[19]	P. Girard, M. Ducreux, P. Baldeyrou, et al., “Surgery for Lung Metastases from Colorectal Cancer: Analysis of Prognostic Factors,” Journal of Clinical Oncology, Vol. 14, No. 7, 1996, pp. 2047-2053.
[20]	G. A. P. Hospers, M. Scaapveld, J. W. R. Nortier, et al., “Randomised Phase III Study of Biweekly 24-h Infusion of High Dose 5FU with Folinic Acid and Oxaliplatin versus Monthly Plus 5-FU/Folinic Acid in First-Line Treatment of Advanced Colorectal Cancer,” Annals of Oncology, Vol. 17, No. 3, 2006, pp. 443-449. Hdoi:10.1093/annonc/mdj104
[21]	P. Rougier, E. Van Custem, E. Bajetta, et al., “Randomised Trial of Irinotecan versus Fluorouracil by Continuous Infusion after Fluorouracil Failure in Patients with Metastatic Colorectal Cancer,” The Lancet, Vol. 352, No. 9138, 1998, pp. 1407-1412. Hdoi:10.1016/S0140-6736(98)03085-2
[22]	G. Portier, D. Elias, O. Bouche, et al., “Multicentre Randomized Trial of Adjuvant Fluorouracil and Folinic Acid Compared with Surgery Alone after Resection of Colorectal Liver Metastases: FFCD ACHBTH AURC 9002 Trial,” Journal of Clinical Oncology, Vol. 24, No. 31, 2006, pp. 4976-4982. Hdoi:10.1200/JCO.2006.06.8353
[23]	B. Nordlinger, H. Sorbye, B. Glimelius, et al., “Perioperative Chemotherapy with FOLFOX4 and Surgery versus Surgery Alone for Resectable Liver Metastases from Colorectal Cancer (EORTC Intergroup Trial 40983): A Randomized Controlled Trial,” The Lancet, Vol. 371, No. 9617, 2008, pp. 1007-1016. Hdoi:10.1016/S0140-6736(08)60455-9