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Hepatic arterial infusion after curative resection of colorectal cancer metastases: A meta-analysis of prospective clinical trials

  • Published:
Journal of Gastrointestinal Surgery

Abstract

The use of hepatic arterial infusion (HAI) for the delivery of chemotherapeutic agents to treat residual microscopic disease after curative hepatic resection for colorectal cancer metastases remains controversial. In recent years, a number of studies examining adjuvant HAI have shown conflicting results. A meta-analysis of prospective clinical trials was performed to determine if adjuvant HAI confers a survival benefit in this setting. Tworeviewers independently performed a literature search ofMEDLINE, PubMed, EMBASE, the Cochrane library, and the Cochrane Clinical Trials Registry. Prospective clinical trials comparing hepatic arterial chemotherapy after curative hepatic resection for colorectal cancer metastases against a control arm were included. Non-English-language publications were excluded. The outcome measure was survival difference at 1 and 2 years after surgery. Seven studies met the inclusion criteria, and all except one were randomized trials. The survival difference in months (positive values favoring the treatment arm) was 1.8 at 1 year (95% confidence interval, -4.9, 8.5) and 9.6 at 2 years (95% confidence interval, -2.2, 21.4). Neither was statistically significant (at 2 years, P = 0.11). Based on these findings, routine adjuvant HAI after curative resection for colorectal cancer of the liver cannot be recommended. However, given the trend toward a survival benefit at 2 years, further study is recommended.

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Authors and Affiliations

  1. Department of Surgery, Brigham and Women’s Hospital, 75 Francis St., 02115, Boston, MA

    Thomas E. Clancy M.D. & Michael J. Zinner M.D.

  2. Department of Surgery, University of Calgary, Calgary, Alberta, Canada

    Elijah Dixon M.D. & Francis R. Sutherland M.D.

  3. Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts

    Roy Perlis M.D.

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  1. Thomas E. Clancy M.D.
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  2. Elijah Dixon M.D.
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  4. Francis R. Sutherland M.D.
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  5. Michael J. Zinner M.D.
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Clancy, T.E., Dixon, E., Perlis, R. et al. Hepatic arterial infusion after curative resection of colorectal cancer metastases: A meta-analysis of prospective clinical trials. J Gastrointest Surg 9, 198–206 (2005). https://doi.org/10.1016/j.gassur.2004.07.004

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