Five-year survival following hepatic resection after neoadjuvant therapy for nonresectable colorectal [liver] metastases

R. Adam, E. Avisar, A. Ariche, S. Giachetti, D. Azoulay, D. Castaing, F. Kunstlinger, F. Levi, F. Bismuth

Research output: Contribution to journalArticle

608 Scopus citations

Abstract

Background: Surgical resection is the most effective treatment for colorectal liver metastases but only a minority of patients are candidates for a potentially curative resection. Our experience with neoadjuvant chemotherapy followed by resection and five years survival analysis of the patients treated is presented. Methods: Between February of 1988 and September of 1996, 701 patients with unresectable colorectal liver metastases were treated with neoadjuvant chemotherapy. Four categories of nonresectable disease were defined: large size, ill location, multinodularity, and extrahepatic disease. Liver resection was performed in those patients whose disease became resectable. After resection, the patients were followed up every 3 months. A 5-year survival analysis by the different categories described was performed. Results: Ninety-five patients (13.5%) were found to be resectable on reevaluation and underwent a potentially curative resection. There was no perioperative mortality, and the complication rate was 23%. As of December of 1999, 87 patients have completed 5 years of follow-up. The overall 5-year survival is 35% from the time of resection and 39% from the onset of chemotherapy. Respective 5-year survival rates are 60% for large tumors, 49% for ill-located lesions, 34% for multinodular disease, and 18% for liver metastases with extrahepatic disease. In this latter category, however, a 35% 5-year survival was found when all the patients with extrahepatic disease were analyzed rather than only those for whom extrahepatic disease was the main cause of nonresectability. Conclusions: Neoadjuvant chemotherapy enables liver resection in some patients with initially unresectable colorectal metastases. Long-term survival is similar to that reported for a priori surgical candidates.

Original languageEnglish (US)
Pages (from-to)347-353
Number of pages7
JournalAnnals of Surgical Oncology
Volume8
Issue number4
DOIs
StatePublished - Jan 1 2001
Externally publishedYes

Keywords

  • Chronotherapy
  • Colorectal liver metastases
  • Neoadjuvant therapy
  • Nonresectable hepatic metastases

ASJC Scopus subject areas

  • Surgery
  • Oncology

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