Clinical

Single resection colorectal cancer and liver metastases offers benefits

Last Updated: 2007-03-19 14:45:00 -0400 (Reuters Health)

By Karla Gale

NEW YORK (Reuters Health) - For patients with synchronous colorectal cancer and liver metastases, the traditional course of treatment has been colorectal cancer resection, followed by chemotherapy and then hepatic resection if the disease has not progressed.

But this approach is not always the best strategy for some patients, according to a presentation last Saturday in a plenary session at the Society of Surgical Oncology's 60th Annual Cancer Symposium in Washington, DC.

For some patients with relatively minor liver involvement, simultaneous colorectal and hepatic resections can be performed safely, presenter Dr. Bryan M. Clary, from Duke University Medical Center in Durham, North Carolina, told Reuters Health.

Dr. Clary and his associates evaluated outcomes from 545 colorectal cancer patients who had liver metastases removed by hepatectomy prior to 2006 and who survived the surgery. Of these, 110 patients underwent simultaneous resections and 435 underwent the staged procedure.

The physicians observed no significant differences in overall or disease-free survival. Five-year survival was 49% for both groups. The study results show that overall hospital stay was lower for simultaneous resections (median 8.5 versus 14 days). If hepatectomy was minor, simultaneous resection did not increase mortality or severe morbidity.

Dr. Clary noted that delaying chemotherapy actually makes hepatectomy safer when few, relatively small tumors are present, because the hepatotoxic effects of chemotherapy are avoided and the liver is more easily resected.

"That's not to say that some patients don't require chemotherapy prior to hepatectomy," he added.

For very large liver tumors, prehepatectomy chemotherapy can reduce the size of the tumor so it can be resected, he said. For patients with extensive liver involvement requiring complex operations, staged surgeries remain the better treatment choice to avoid severe postoperative morbidity.

"These days, there is a more liberal definition of what is resectable," Dr. Clary said. "If all clinically evident disease can be removed, while leaving that person with enough liver tissue that it can function, that in general is the standard definition of 'resectable' for healthy patients."

Dr. Clary estimates that about half of patients with colorectal and liver tumors may be good candidates for simultaneous surgery. However, he cautioned, a multidisciplinary center is required that includes medical and surgical oncologists skilled in colorectal surgery, as well as surgeons specialized in liver surgery.