Colorectal hepatic metastases - Resection, local ablation, and hepatic artery infusion pump are associated with prolonged survival

Background: Treatment of metastatic colorectal cancer to the liver is not u niform. We describe the management of metastatic colorectal cancer of the l iver at a single institution during a 10-year period. Methods: From January 1, 1990, through December 31, 1999, 174 patients were identified from the tumor registry at the University of Alabama at Birming ham with a diagnosis of metastatic colorectal cancer to the liver. Patient, tumor, laboratory, operative, and adjuvant therapy factors were analyzed, with overall survival as the endpoint. Log-rank tests were used for univari ate analysis, Cox-proportional hazards model for multivariate analysis, and Kaplan-Meier curves were used for graphical representation of survival. Si gnificance was defined as P<.05. Results: Median age was 60 years (age range, 18-92 years). Seventy-nine per cent of patients had synchronous liver metastases at the time of diagnosis of the primary colorectal tumor. The primary tumor was in the colon and rec tum 75% and 25% of the time, respectively. Of the 89 patients who underwent operation, 73 received definitive surgical treatment for their liver metas tases. Fifty-two patients underwent lobectomy or wedge resection, 5 underwe nt cryotherapy, and 16 had a hepatic artery infusion pump (HAIP) inserted. Median follow-up duration of surgically treated patients was 26 months. Ope rative mortality was 1.3%. The 3-year actuarial survivals for patients who underwent resection, HAIP, or chose with unresectable disease were 70 month s, 32 months, and 3 months, respectively (P<.001). By multivariate analysis , surgical intervention, a carcinoembryonic antigen level less than 200 mug /L, or a low T stage of the primary tumor were associated with prolongation of survival. Conclusions: Surgical resection should be attempted for hepatic colorectal metastases, as this is associated with prolonged overall survival. Hepatic artery infusion pump insertion seems to prolong overall survival for those with unresectable hepatic metastases, but it is not equal to resection. Agg ressive surgical management of patients with hepatic colorectal metastases is safe, may prolong overall survival, and therefore should be considered i n all patients with metastases confined to the liver.