[Adjuvant regional arterial port chemotherapy after resection of colorectal liver metastases]

Abstract

Between 1986 and 1995 we performed radical hepatic resections (R0 resections) in 109 patients with hepatic metastases following colorectal carcinoma. 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 repeated courses. In 9 patients, the treatment had to be withdrawn because of complications. The remaining 59 patients were not treated. In 73% of the patients after port implantation mostly minor complications occurred during chemotherapy. Our results confirmed a markedly increased 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 survival rates of both groups were not different. The frequency, localization, and resectability of recurrences were not influenced by adjuvant chemotherapy. However, the lengthening of mean survival time in the treated group might reflect a delay in the occurrence of early recurrences. In conclusion, adjuvant hepatic arterial chemotherapy following resection 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 R0 resections of colorectal hepatic metastases in our series. Taking into account the high rate of local complications of the port systems in our series, angiographic controls are strongly recommended prior to each chemotherapeutic cycle.