SAN DIEGOHistorically, cancer patients with liver metastases
that were bilobar or noncolorectal, or who were simply elderly, have
been considered inappropriate candidates for hepatic resection. A new
study from the University of Chicagos Pritzker School of
Medicine suggests that these indications for resection should be liberalized.
Joseph F. Buell, MD, assistant professor of surgery, University of
Cincinnati, reported the results in a poster session at the Society
for Surgery of the Alimentary Tract (SSAT) annual meeting held during
the Digestive Disease Week con-ference.
Dr. Buell and his colleagues identified 77 nontraditional resection
candidates and compared them to 63 traditional resection candidates
with unilobar colo-rectal cancer liver metastases who were younger
than age 70.
The nontraditional group was composed of 21 colorectal cancer
patients older than 70, 25 patients with bilobar colorectal cancer
liver metastases, and 31 with non-colorectal cancer metastases.
Length of hospital stay, 90-day mortality, and morbidity rates were
similar for the traditional and nontraditional groups.
Disease-free survival at 1, 3, and 5 years for the traditional group
was 93%, 60%, and 49%, respectively, vs 81%, 41%, and 23% for the
nontraditional group (P < .008).
Dr. Buell found that the patients with bilobar disease had a
significantly decreased disease-free period from the time of the
primary resection to metastatic disease, compared with the
traditional colo-rectal cancer group.
Patients over 70 with colorectal cancer had a 5-year survival rate
equivalent to that of the traditional colorectal cancer group (42% vs
49%), but patients with bilobar liver cancer had a decreased 5-year
Patients with non-colorectal cancer metastases had a decreased 3-year
survival rate, compared with the traditional colorectal cancer group.
Hepatic resection in nontraditional patients can be performed with
minimal morbidity and mortality, Dr. Buell concluded.
He said that despite the decreased survival rates in the
nontraditional patients, particularly those with bilobar disease or non-colorectal
cancer metastases, when this group is compared with traditional
colorectal cancer patients, the survival approximates those
historically reported for resection of hepatic colorectal cancer metastases.
There is a benefit, Dr. Buell said. Were not
changing the pace of the disease, but we are prolonging survival,
because patients are not dying from their liver disease.