Background
We investigated perioperative complications of hepatic arterial infusion chemotherapy
preceding major hepatectomy for multiple bilobar colorectal cancer metastases. No
consensus exists concerning operative feasibility or perioperative course in patients
undergoing major liver resection with neoadjuvant chemotherapy—partly because such
chemotherapy is considered hepatotoxic, increasing the risk of postoperative liver
failure.
Methods
Clinicopathologic data were available for 41 consecutive patients with 5 or more bilobar
liver metastases from colorectal cancer who underwent major liver resection with or
without prior hepatic arterial chemotherapy. Data concerning operative feasibility,
postoperative liver function, complication rates, and histologic findings in the non-neoplastic
liver were analyzed retrospectively.
Results
Prehepatectomy and postoperative day 1 platelet counts were lower (P < .01 and P < .05), alkaline phosphatase on postoperative day 3 was higher (P < .01), and prothrombin time on day 1 was more prolonged (P < .01) in the chemotherapy group. No significant difference was seen between groups
in intraoperative data, morbidity, or duration of hospitalization. Histologic examination
of adjacent non-neoplastic liver confirmed mild to severe fatty degeneration in 91%
of the patients undergoing neoadjuvant chemotherapy, compared with 53% in those without
neoadjuvant chemotherapy (P = .023). Although the number of neoplasms in chemotherapy patients was greater than
that of the other group, overall and disease-free survival rates were comparable between
groups.
Conclusions
Despite mild postoperative liver dysfunction, pre-resection hepatic arterial chemotherapy
did not increase morbidity.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Multivariate analysis of a personal series of 247 consecutive patients with liver metastases from colorectal cancer. Treatment by hepatic resection.Ann Surg. 1984; 199: 306-316
- Hepatic metastases from colorectal carcinoma.Br J Surg. 1990; 77: 1241-1246
- Surgical treatment of hepatic metastases from colorectal cancer.Arch Surg. 1976; 111: 330
- Liver resection for metastatic colorectal cancer.Surgery. 1986; 100: 804-809
- Resection of the liver for colorectal carcinoma metastases.Surgery. 1988; 103: 278-288
- Resection of nonresectable liver metastases from colorectal cancer after neoadjuvant chemotherapy.Ann Surg. 1996; 224: 509-522
- Importance of response to neoadjuvant chemotherapy in patients undergoing resection of synchronous colorectal liver metastases.J Gastrointest Surg. 2003; 7: 109-117
- Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy.Ann Surg. 2004; 240: 644-658
- Role of neoadjuvant chemotherapy in the treatment of multiple colorectal metastases to the liver.Br J Surg. 2003; 90: 963-969
- Two-stage hepatectomy.Ann Surg. 2000; 232: 777-785
- Long-term survival of patients with unresectable colorectal cancer liver metastases following infusional chemotherapy with 5-fluorouracil, leucovorin, oxaliplatin and surgery.Ann Oncol. 1999; 10: 663-669
- Five-year survival following hepatic resection after neoadjuvant therapy for nonresectable colorectal [liver] metastases.Ann Surg Oncol. 2001; 8: 347-353
- Outcome of high-dose chemotherapy and autologous stem-cell transplantation in stage IIIB inflammatory breast cancer.J Clin Oncol. 1999; 17: 2006-2014
- Treatment-induced pathologic necrosis.J Clin Oncol. 2001; 19: 3203-3209
- Tumor progression while on chemotherapy.Ann Surg. 2004; 240: 1052-1064
- Effectiveness of pre-hepatectomy intra-arterial chemotherapy for multiple bilobar colorectal cancer metastases to the liver.Surgery. 2005; 137: 156-164
- Effects of preoperative chemotherapy on liver function tests after hepatectomy.Hepatogastroenterology. 2001; 48: 1406-1408
- Resection of nonresectable liver metastases from colorectal cancer after percutaneous portal vein embolization.Ann Surg. 2000; 231: 480-486
- Risk factors before hepatectomy, hepatic function after hepatectomy and computed tomographic changes as indicators of mortality from hepatic failure.Surg Gynecol Obstet. 1989; 169: 17-26
- Frequency, technical aspects, results, and indications of major hepatectomy after prolonged intra-arterial hepatic chemotherapy for initially unresectable hepatic tumors.J Am Coll Surg. 1995; 180: 213-219
- Lobes et segments hépatiques. Notes sur l’architecture anatomique et chirurgicale du foie.Press Med. 1954; 62: 709-712
- Randomised multicentre trial of chronotherapy with oxaliplatin, fluorouracil, and folinic acid in metastatic colorectal cancer.Lancet. 1997; 350: 681-686
- Circadian chronotherapy for human cancers.Lancet Oncol. 2001; 2: 307-315
- Handbook for reporting results of cancer treatment. World Health Organization, Geneva1979 (WHO offset publication no. 48)
- A prediction scoring system to select the surgical treatment of liver cancer. Further refinement based on 10 years of use.Ann Surg. 1994; 219: 342-346
- The Brisbane 2000 Terminology of Liver Anatomy and Resection.HPB. 2000; 2: 333-339
- Liver pathology following hepatic arterial infusion chemotherapy. Hepatic toxicity with FUDR.Cancer. 1986; 58: 855-861
- Biliary sclerosis in patients receiving hepatic arterial infusions of floxuridine.J Clin Oncol. 1985; 3: 98-102
- ‘Natural history’ of hepatectomy.Br J Surg. 1992; 79: 39-42
- Enzyme and function changes after extended liver resection in man.Ann Surg. 1969; 169: 111-119
- Safety of hemihepatic vascular occlusion during resection of the liver.Surg Gynecol Obstet. 1987; 164: 155-158
- Morphological changes after intra-arterial chemotherapy of the liver.Hepatogastroenterology. 1987; 34: 5-9
- Hepatic artery pump infusion.J Clin Oncol. 1984; 2: 595-600
- Perioperative complications in patients undergoing major liver resection with or without neoadjuvant chemotherapy.J Gastrointest Surg. 2003; 7: 1082-1088
- Effect of 5-fluorouracil on liver regeneration and metabolism after partial hepatectomy in the rat.Cancer. 1978; 41: 435-443
- Regional pharmacokinetics of 5-bromo-2’-deoxyuridine and 5-fluorouracil in dogs.Cancer Res. 1996; 56: 4724-4727
- Clinical pharmacology of intraarterial cis-diaminedichloroplatinum (II).Cancer Res. 1983; 43: 917-920
Article info
Publication history
Accepted:
September 18,
2005
Identification
Copyright
© 2006 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
