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Effects of systemic and regional chemotherapy after hepatic resection for colorectal metastases

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Abstract

Background: Although the survival benefit of hepatic resection for colorectal metastasis has been established, some controversy remains regarding the significance of adjuvant chemotherapy after hepatic resection.

Methods: One hundred thirty-two consecutive patients who had liver resection for colorectal metastasis at our hospital between 1980 and 1997 were studied. After curative hepatic resection, 37 patients underwent systemic chemotherapy, administered orally or intraportally. Forty patients had no adjuvant chemotherapy. The chemotherapeutic agents used for oral administration were uracil and Tegafur or Tegafur alone. Mitomycin C (MMC) or 5-FU was used for IV chemotherapy. Combinations of 5-FU/leucovorin or MMC/5-FU (doxorubicin) were used for regional chemotherapy. Univariate and multivariate analyses were applied to test the significance of adjuvant chemotherapy for patient survival or disease-free survival.

Results: Overall 5-year survival was 42.2% (95% CL: 31.2%, 53.2%). Among the possible prognostic factors studied, univariate analysis showed a significant difference in survival based on the number of tumors and lymph node metastases in the hepatic hilum. There was a significant difference in disease-free survival based on adjuvant chemotherapy and lymph node metastasis. The multivariate analysis for patient survival selected four prognostic factors (P<.05), including adjuvant chemotherapy, lymph node metastasis, disease-free interval, and tumor size. The multivariate analysis for disease-free survival selected adjuvant chemotherapy, lymph node metastasis, and disease-free interval as significant factors. The most common recurrence site was remnant liver, regardless of adjuvant chemotherapy.

Conclusions: Adjuvant chemotherapy significantly improved survival and disease-free survival after hepatic resection for colorectal metastases. It did not decrease recurrence rate in the remnant liver.

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References

  1. Foster JH, Berman MM. Resection of metastatic tumors. Solid liver tumours.Major Problems in Clinical Surgery. Philadelphia: WB Saunders, 1977:209–35.

    Google Scholar 

  2. Hughes KS, Simon R, Songhorabodi S. Resection of the liver for colorectal carcinoma metastases: a multi-institutional study of patterns of recurrence.Surgery 1986;100:278–84.

    CAS  PubMed  Google Scholar 

  3. Foster JH. Survival after liver resection for secondary tumors.Am J Surg 1978;135:389–94.

    Article  CAS  PubMed  Google Scholar 

  4. Fortner JG, Silva JS, Golbey RB, Cox EB, MacLean BJ. Multivariate analysis of a personal series of 247 consecutive patients with liver metastases from colorectal cancer.Ann Surg 1984;199:306–16.

    CAS  PubMed  Google Scholar 

  5. Fujii S, Kitano S, Ukenaka K, Shirasaka T. Effect of co-administration of uracil or cytosine on the antitumor activity of clinical doses of 1-(2 tetrahydrofuyl)-5-fluorouracil and level of 5-fluorouracil in rodens.Gann 1979;70:209–14.

    CAS  PubMed  Google Scholar 

  6. Harada M, Nishitani H, Koga K, Miura I, Umeno Y. Metabolism of tegafur in rat liver observed by in vivo 19F magnetic resonance spectroscopy and chromatography.Jpn J Cancer Res 1992;83:387–91.

    CAS  PubMed  Google Scholar 

  7. Tolamide H, Akiyoshi H, Minato Y, Okuda H, Fujii S. Comparative studies on the metabolism of 2-(tetrahydrofuryl)-5-fluorouracil and 5-fluorouracil.Gann 1977;68:553–60.

    Google Scholar 

  8. Falcone A, Pfanner E, Ricci S, et al. Oral doxifluridine in elderly patients with metastatic colorectal cancer: a multicenter phase II study.Ann Oncol 1994;5:760–2.

    CAS  PubMed  Google Scholar 

  9. Ueno M, Ohta H, Hori M, et al. Hepatic resection for colorectal liver metastasis influence on survival of clinical factors and surgery [in Japanese].Jpn J Coloproctology [Nihon daichokoumonbyo kaishi] 1991;44:38–45.

    Google Scholar 

  10. Beckurts KTE, Holscher AH, Thorban St, Bollschweiler E, Siewert JR. Significance of lymph node involvement at the hepatic hilum in the resection of colorectal liver metastases.Br J Surg 1997;84:1081–4.

    Article  CAS  PubMed  Google Scholar 

  11. Hughes KS, Rosenstein RB, Songhorabodi S, et al. Resection of the liver for colorectal carcinoma metastases: a multi-institutional study of long-term survivors.Dis Colon Rectum 1988;31:1–4.

    CAS  PubMed  Google Scholar 

  12. Sugihara K, Hojo K, Moriya Y, Yamasaki S, Kosuge T, Takayama T. Pattern of recurrence after hepatic resection for colorectal metastases.Br J Surg 1993;80:1032–5.

    CAS  PubMed  Google Scholar 

  13. Cady B, Stone MD, McDermott WV, et al. Technical and biological factors in disease-free survival after hepatic resection for colorectal cancer metastasis.Arch Surg 1992;127:561–9.

    CAS  PubMed  Google Scholar 

  14. Ekberg H, Tranberg K-G, Andersson R, Lundstedt C, Hagerstrand I, Ranstam J, Bengmark S. Pattern of recurrence in liver resection for colorectal secondaries.World J Surg 1987;11:541–7.

    Article  CAS  PubMed  Google Scholar 

  15. Iwatsuki S, Esquivel CO, Gordon RD, Starzl TE. Liver resection for metastatic colorectal cancer.Surgery 1986;100:804–10.

    CAS  PubMed  Google Scholar 

  16. Gayowski TJ, Iwatsuki S, Madariaga JR, Selby R, Todo S, Irish W, Starzl TE. Experience in hepatic resection for metastatic colorectal cancer: analysis of clinical and pathological risk factors.Surgery 1994;116:703–11.

    CAS  PubMed  Google Scholar 

  17. Rosen CB, Nagorney DM, Taswell HF, Helgeson SL, Ilstrup DM, van Heerden JA, Adson MA. Perioperative blood transfusion and determinants of survival after liver resection for metastatic colorectal carcinoma.Ann Surg 1992;216:493–505.

    CAS  PubMed  Google Scholar 

  18. Chang A, Schneider PD, Sugarbaker PH, Simpson C, Culnane M, Steinberg SM. A prospective randomized trial of regional versus systemic continuous 5-fluorodeoxyuridine chemotherapy in the treatment of colorectal liver metastases.Ann Surg 1987;206:685–93.

    CAS  PubMed  Google Scholar 

  19. Cox DR. Regression models and life tables.Journal of the Royal Statistical Society 1972;B34:187–220.

    Google Scholar 

  20. Hohn DC, Stagg RJ, Friedmann MA, Hannigan JF Jr, Raynor A, Ignoffo RJ. A randomized trial of continuous intravenous versus hepatic intraarterial floxuridine in patients with colorectal cancer metastatic to the liver: the Northern California Oncology Group trial.J Clin Oncol 1989;7:1646–54.

    CAS  PubMed  Google Scholar 

  21. Kemeny N, Daly J, Reichman B, Geller N, Botet J, Oderman P. Intrahepatic or systemic infusion of fluorodeoxyuridine in patients with liver metastases from colorectal carcinoma. A randomized trial.Ann Intern Med 1987;107:459–65.

    CAS  PubMed  Google Scholar 

  22. Martin JK Jr, O'Connell MJ, Wieand HS, Fitzgibbons RJ Jr, Mailliard JA, Rubin J. Intra-arterial floxiuridine vs systemic fluorouracil for hepatic metastases from colorectal cancer. A randomized trial.Arch Surg 1990;125:1022–7.

    PubMed  Google Scholar 

  23. Meta-analysis Group In Cancer. Reappraisal of hepatic arterial infusion in the treatment of nonresectable liver metastases from colorectal cancer.J Natl Cancer Inst 1996;88:252–8.

    Google Scholar 

  24. Kemeny N, Goldberg D, Beatty D, et al. Results of a prospective randomized trial of continuous regional chemotherapy and hepatic resection as treatment of hepatic metastases from colorectal primaries.Cancer 1986;57:492–8.

    CAS  PubMed  Google Scholar 

  25. Lygidakis NJ, Ziras N, Parissis J. Resection versus resection combined with adjuvant pre- and post-operative chemotherapy-immunotherapy for metastatic colorectal liver cancer.Hepatogastroenterology 1995;42:155–61.

    CAS  PubMed  Google Scholar 

  26. Okuno K, Shigeoka H, Lee YS, et al. Adjuvant hepatic arterial IL-2 and MMC, 5-FU after curative resection of colorectal liver metastases.Hepatogastroenterology 1996;43:688–91.

    CAS  PubMed  Google Scholar 

  27. Archer SGM, Gray BN. Vascularization of small liver metastases.Br J Surg 1989;76:545–8.

    CAS  PubMed  Google Scholar 

  28. Fielding LP, Hittinger R, Grace RH, Fry JS. Randomized controlled trial of adjuvant chemotherapy by portal-vein perfusion after curative resection for colorectal adenocarcinoma.Lancet 1992;340:502–6.

    CAS  PubMed  Google Scholar 

  29. Tsujitani S, Watanabe A, Kakeji Y, Maehara Y, Tomoda H, Furusawa M, Sugimachi K. Hepatic recurrence not prevented with low-dosage long-term intraportal 5-FU infusion after resection of colorectal liver metastasis.Eur J Surg Oncol 1991;17:526–9.

    CAS  PubMed  Google Scholar 

  30. Davis HL. Chemotherapy of large bowel cancer.Cancer 1982;50:2638–46.

    CAS  PubMed  Google Scholar 

  31. Malik STA, Talbot D, Clarke PI. Phase II trial of UFT in advanced colorectal and gastric cancer.Br J Cancer 1990;62:1023–5.

    CAS  PubMed  Google Scholar 

  32. Baron MG, Feliu J, Biron CG, et al. UFT modulated with leucovorin in advanced colorectal cancer: oncopaz experience.Oncology 1997;54(suppl 1):24–9.

    CAS  Google Scholar 

  33. Pazdur R, Lassere Y, Rhodes V, et al. Phase II trial of uracil and tegafur plus oral leucovorin: an effective oral regimen in the treatment of metastatic colorectal carcinoma.J Clin Oncol 1994;12:2296–300.

    CAS  PubMed  Google Scholar 

  34. Pazdur R, Covington WP, Brown NS, Lassere Y, Diaz-Canton E, Ho DH. Comparative steady state pharmacokinetics of oral UFT versus protracted intravenous 5-fluorouracil (FU).Proc Am Soc Clin Oncol 1996;14:474.

    Google Scholar 

  35. Patt YZ, McBride CM, Ames FC, et al. Adjuvant perioperative hepatic arterial mitomycin C and floxuridine combined with surgical resection of metastatic colorectal cancer in the liver.Cancer 1987;59:867–73.

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Cancer Chemotherapy Center, Cancer Institute (AK), Tokyo, Japan

    Keisuke Aiba MD

  2. Dept. of Surgery, Cancer Institute Hospital, 1-37-1 Kami-Ikebukuro, Toshima-ku, 170-8455, Tokyo, Japan

    Norihiro Kokudo MD, Makoto Seki MD, Hirotoshi Ohta MD, Kaoru Azekura MD, Masashi Ueno MD, Tadao Sato MD, Akihito Moroguchi MD, Toshiki Matsubara MD, Takashi Takahashi MD & Toshifusa Nakajima MD

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  1. Norihiro Kokudo MD
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  2. Makoto Seki MD
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  3. Hirotoshi Ohta MD
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  4. Kaoru Azekura MD
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Kokudo, N., Seki, M., Ohta, H. et al. Effects of systemic and regional chemotherapy after hepatic resection for colorectal metastases. Annals of Surgical Oncology 5, 706–712 (1998). https://doi.org/10.1007/BF02303481

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  • DOI: https://doi.org/10.1007/BF02303481

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