Clinical Patterns of Failure After Resection of Colon and Rectum Carcinoma Metastases to the Liver

Summary

Data are presented on 43 patients from Brigham and Women’s Hospital who underwent major hepatic resections for cure of primary and secondary liver tumors. These included 30 asymptomatic colorectal cancer patients with single or multiple resectable hepatic metastases. The results of this series of patients were analyzed by carefully documenting the clinical patterns of failure of the surgical procedures. The results reinforce the value of serial elevation of carcinoembryonic antigen as the best indicator of recurrence in predominantly asymptomatic patients. Not surprising based on the natural history of the disease is the observation that the majority of unresected patients die from liver failure whereas following hepatic resection, death results predominantly from failure outside of the liver. Thus, the pattern of failure after resection of hepatic metastases suggests that the proximate cause of death in these patients has been changed. Although the data confirm the safety of major hepatic resection performed properly on selected patients, the single most important predictor of local hepatic recurrence in patients with metastatic disease was the lack of clean margins at the time of the initial hepatic resection. Hence, while failure due to hepatic involvement may be prevented surgically, initiation of systemic adjuvant therapy protocols after liver resection should be our treatment goal. To accomplish this objective, however, more effective systemic therapy for large bowel cancer must be developed.