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

Background: Although the survival benefit of hepatic resection for colorect al 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 resectio n for colorectal metastasis at our hospital between 1980 and 1997 were stud ied. After curative hepatic resection, 37 patients underwent systemic chemo therapy, administered orally or intravenously, and 38 patients underwent re gional chemotherapy, given intra-arterially or intraportally. Forty patient s had no adjuvant chemotherapy. The chemotherapeutic agents used for oral a dministration were uracil and Tegafur or Tegafur alone. Mitomycin C (MMC) o r 5-FU was used for TV chemotherapy. Combinations of 5-FU/leucovorin or MMC /5-FU (doxorubicin) were used for regional chemotherapy. Univariate and mul tivariate analyses were applied to test the significance of adjuvant chemot herapy for patient survival or disease-free survival. Results: Overall 5-year survival was 42.2% (95% CL: 31.2%, 53.2%). Among th e possible prognostic factors studied, univariate analysis showed a signifi cant difference in survival based on the number of tumors and lymph node me tastases in the hepatic hilum. There was a significant difference in diseas e-free survival based on adjuvant chemotherapy and lymph node metastasis. T he multivariate analysis for patient survival selected four prognostic fact ors (P < .05), including adjuvant chemotherapy, lymph node metastasis, dise ase-free interval, and tumor size. The multivariate analysis for disease-fr ee survival selected adjuvant chemotherapy, lymph node metastasis, and dise ase-free interval as significant factors. The most common recurrence site w as remnant liver, regardless of adjuvant chemotherapy. Conclusions: Adjuvant chemotherapy significantly improved survival and dise ase-free survival after hepatic resection for colorectal metastases. It did not decrease recurrence rate in the remnant liver.