Local Surgical Treatment of Hepatic Metastases from Colorectal Carcinoma: Survival Times and Sites of Recurrence
This chapter summarizes the experience at Roswell Park Memorial Institute with resectable liver metastases and with hepatic artery ligation for unresectable metastases from colorectal carcinoma. Survival times and patterns of recurrence were noted in 36 patients with documented colorectal adenocarcinoma metastatic to the liver who underwent resection. The overall median survival time following liver resection was 22 months. Survival was not influenced by the type of surgical resection performed. Survival time following resection of solitary lesions was 28 months and following resection of multiple lesions, 21 months. The difference between survival times of patients with synchronous metastases (25 months) and patients with metachronous metastases (16 months) from the time of liver resection was not statistically significant. Patterns of recurrence revealed that 11 of 17 patients experienced recurrences in the liver and in extrahepatic sites. Only two patients died with recurrent metastasis only in the liver.
From April 1975 to January 1982, 97 patients underwent hepatic artery ligation for biopsyroven metastatic adenocarcinoma of the colon and rectum. All patients undergoing ligation had 50% or more of their liver involved with metastases. The overall median survival time was 10 months. The survival rate was determined in relation to performance status, preoperative alkaline phosphatase and total bilirubin levels, and the presence of extrahepatic intra abdominal disease. We cannot conclude that hepatic artery ligation is an effective means of treating unresectable liver metastases from this retrospective study. What can be concluded is that important patient stratifications in predicting survival time must be taken into consideration for evaluating any form of treatment for unresectable liver metastases. The median survival time for patients with 0–1 performance status was 12 months. Patients with preoperative alkaline phosphatase levels less than two times normal also had a median survival time of 12 months. For patients with total bilirubin levels of less than two times normal the median survival time was four months.
KeywordsToxicity Adenocarcinoma Oncol Stratification Bilirubin
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