ADJUVANT REGIONAL CHEMOTHERAPY FOLLOWING RESECTION OF COLORECTAL HEPATIC METASTASES

Between 1986 and 1995 we performed radical hepatic resections (RO rese ctions) in 109 patients with hepatic metastases following colorectal c arcinoma. In 50 patients a hepatic arterial port device was implanted for adjuvant regional chemotherapy (HAI). Mitomycin C, 5-fluorouracil, and since 1993 folinic acid have been administered during 6 monthly r epeated courses. In 9 patients, the treatment had to be withdrawn beca use of complications. The remaining 59 patients were not treated. In 7 3 % of the patients after port implantation mostly minor complications occurred during chemotherapy. Our results confirmed a markedly increa sed survival rate during the first 3 postoperative years, followed by a prolongation of median survival time of treated patients compared to untreated patients. Nevertheless, the observed differences of median survival were not statistically different. In contrast, the 5-year sur vival rates of both groups were not different. The frequency, localiza tion, and resectability of recurrences were not influenced by adjuvant chemotherapy However, the lengthening of mean survival time in the tr eated group might reflect a delay in the occurrence of early recurrenc es. In conclusion, adjuvant hepatic arterial chemotherapy following re section of colorectal hepatic metastases might be able to prolong the time until recurrence, but does not help to avoiding it. Therefore, it did not increase the rate of cure following RO resections of colorect al hepatic metastases in our series. Taking into account the high rate of local complications of the port systems in our series, angiographi c controls are strongly recommended prior to each chemotherapeutic cyc le.