The role of surgery in the treatment of liver metastases for colorectal cancer patients

BACKGROUND/AIMS: Liver metastases deriving from colorectal cancer can be tr eated with curative intention in a select number of patients. Controversy d oes, however, persist pertaining to the impact of adjuvant treatment strate gies. The aim of this study is to elucidate upon the various treatment moda lities for patients suffering from liver metastases of colorectal primary t umor as well as to provide a rationale for surgical and adjuvant treatment. METHODOLOGY: From November 1987 to September 1998, a total of 449 consecuti ve patients-suffering from liver metastases deriving from a colorectal canc er were documented at our institution in a prolective study. Prognostic fac tors providing the most beneficial outcome (whether with surgical and/or ad juvant treatment modalities) were analyzed by univariate and multivariate a nalysis. RESULTS: Whenever possible, curative (RO) surgical resection of colorectal liver metastases provides the most benefit to the patient. Multivariate ana lysis revealed tumor infiltration of the lymph nodes of the hepatoduodenal ligament and metachronous occurrence of liver metastases as most independen t factors related to survival. CONCLUSIONS: Adjuvant post-operative chemotherapy fails to significantly im prove survival following resection of liver metastases when compared to the liver resection only group. In patients with unresectable metastases, regi onal arterial chemotherapy did not improve survival significantly when comp ared with systemic chemotherapy.