Annals of Surgical Oncology

, Volume 7, Issue 7, pp 490–495

Surgery After Downstaging of Unresectable Hepatic Tumors With Intra-Arterial Chemotherapy

  • Funda Meric
  • Yehuda Z. Patt
  • Steve A. Curley
  • Judy Chase
  • Mark S. Roh
  • J. Nicolas Vauthey
  • Lee M. Ellis
Original Article

DOI: 10.1007/s10434-000-0490-2

Cite this article as:
Meric, F., Patt, Y.Z., Curley, S.A. et al. Ann Surg Oncol (2000) 7: 490. doi:10.1007/s10434-000-0490-2

Abstract

Background: This retrospective study was performed to assess the outcome among patients who underwent hepatic resection or tumor ablation after hepatic artery infusion (HAI) therapy downstaged previously unresectable hepatocellular carcinoma (HCC) or liver metastases from colorectal cancer (CRC).

Methods: Between 1983 and 1998, 25 patients with HCC and 383 patients with hepatic CRC metastases were treated with HAI therapy for unresectable liver disease. We retrospectively reviewed the records of 26 (6%) of these patients who underwent subsequent surgical exploration for tumor resection or ablation.

Results: At a median of 9 months (range 7–12 months) after HAI treatment, four patients (16%) with HCC underwent exploratory surgery; two underwent resection with negative margins, and the other two were given radiofrequency ablation (RFA) because of underlying cirrhosis. At a median postoperative follow-up of 16 months (range 6–48 months), all four patients were alive with no evidence of disease. At a median of 14.5 months (range 8–24 months) after HAI therapy, 22 patients with hepatic CRC metastases underwent exploratory surgery; 10 underwent resection, 6 underwent resection and RFA or cryotherapy, and 2 underwent RFA only. At a median follow-up of 17 months, 15 (83%) of the 18 patients with CRC who had received surgical treatment had developed recurrent disease; the other 3 died of other causes (1 of postoperative complications) within 7 months of the surgery. One patient in whom disease recurred underwent a second resection and was disease-free at 1 year follow-up.

Conclusions: Hepatic resection or ablation after tumor downstaging with HAI therapy is a viable option for patients with unresectable HCC. However, given the high rate of recurrence of metastases from CRC, hepatic resection or ablation after downstaging with HAI should be used with caution.

Key Words

Hepatic artery infusionChemotherapyColorectal cancerMetastasesHepatocellular cancer

Copyright information

© The Society of Surgical Oncology, Inc. 2000

Authors and Affiliations

  • Funda Meric
    • 1
  • Yehuda Z. Patt
    • 2
  • Steve A. Curley
    • 1
  • Judy Chase
    • 3
  • Mark S. Roh
    • 4
  • J. Nicolas Vauthey
    • 1
  • Lee M. Ellis
    • 1
    • 5
  1. 1.Departments of Surgical OncologyThe University of Texas M. D. Anderson Cancer CenterHouston
  2. 2.Department of Gastrointestinal Medical Oncology and Digestive DiseasesThe University of Texas M. D. Anderson Cancer CenterHouston
  3. 3.Department of PharmacyThe University of Texas M. D. Anderson Cancer CenterHouston
  4. 4.Department of SurgeryAllegheny General HospitalPittsburgh
  5. 5.Department of Surgical OncologyThe University of Texas M. D. Anderson Cancer CenterHouston