Annals of Surgical Oncology

, Volume 14, Issue 7, pp 2078–2087 | Cite as

Recurrence and Survival Outcomes after Hepatic Resection with or without Cryotherapy for Liver Metastases from Colorectal Carcinoma

  • Rui Niu
  • Tristan D. Yan
  • Jacqui C. Zhu
  • Deborah Black
  • Francis Chu
  • David L. Morris
Hepatic and Pancreatic

Abstract

Background

Some reports support resection combined with cryotherapy for patients with multiple bilobar colorectal liver metastases (CRLM) that would otherwise be ineligible for curative treatments. This series demonstrates long-term results of 415 patients with CRLM who underwent resection with or without cryotherapy.

Methods

Between April 1990 and January 2006, 291 patients were treated with resection only and 124 patients with combined resection and cryotherapy. Recurrence and survival outcomes were compared. Kaplan-Meier and Cox-regression analyses were used to identify significant prognostic indicators for survival.

Results

Median length of follow-up was 25 months (range 1–124 months). The 30-day perioperative mortality rate was 3.1%. Overall median survival was 32 months (range 1–124 months), with 1-, 3- and 5-year survival values of 85%, 45% and 29%, respectively. The overall recurrence rates were 66% and 78% for resection and resection/cryotherapy groups, respectively. For the resection group, the median survival was 34 months, with 1-, 3- and 5- year survival values of 88%, 47% and 32%, respectively. The median survival for the resection/cryotherapy group was 29 months, with 1-, 3- and 5-year survival values of 84%, 43% and 24%, respectively (P = 0.206). Five factors were independently associated with an improved survival: absence of extrahepatic disease at diagnosis, well- or moderately-differentiated colorectal cancer, largest lesion size being 4 cm or less, a postoperative CEA of 5 ng/ml or less and absence of liver recurrence.

Conclusions

Long-term survival results of resection combined with cryotherapy for multiple bilobar CRLM are comparable to that of resection alone in selected patients.

Keywords

Hepatic cryotherapy Hepatectomy Liver resection Colorectal liver metastases 

References

  1. 1.
    Simmonds PC, Primrose JN, Colquitt JL, et al. Surgical resection of hepatic metastases from colorectal cancer: a systematic review of published studies. Br J Cancer 2006; 94(7):982–999PubMedCrossRefGoogle Scholar
  2. 2.
    Malafosse R, Penna C, Sa Cunha A, Nordlinger B. Surgical management of hepatic metastases from colorectal malignancies. Ann Oncol 2001; 12(7):887–894PubMedCrossRefGoogle Scholar
  3. 3.
    Choti MA, Sitzmann JV, Tiburi MF, et al. Trends in long-term survival following liver resection for hepatic colorectal metastases. Ann Surg 2002; 235(6):759–766PubMedCrossRefGoogle Scholar
  4. 4.
    Shah SA, Haddad R, Al-Sukhni W, et al. Surgical resection of hepatic and pulmonary metastases from colorectal carcinoma. J Am Coll Surg 2006; 202(3):468–475PubMedCrossRefGoogle Scholar
  5. 5.
    Seifert JK, Morris DL. Prognostic factors after cryotherapy for hepatic metastases from colorectal cancer. Ann Surg 1998; 228(2):201–208PubMedCrossRefGoogle Scholar
  6. 6.
    Yan DB, Clingan P, Morris DL. Hepatic cryotherapy and regional chemotherapy with or without resection for liver metastases from colorectal carcinoma: how many are too many? Cancer 2003; 98(2):320–330PubMedCrossRefGoogle Scholar
  7. 7.
    Shafir M, Shapiro R, Sung M, et al. Cryoablation of unresectable malignant liver tumors. Am J Surg 1996; 171(1):27–31PubMedCrossRefGoogle Scholar
  8. 8.
    Seifert JK, Junginger T, Morris DL. A collective review of the world literature on hepatic cryotherapy. J R Coll Surg Edinb 1998; 43(3):141–154PubMedGoogle Scholar
  9. 9.
    Gruenberger T, Jourdan JL, Zhao J, et al. Reduction in recurrence risk for involved or inadequate margins with edge cryotherapy after liver resection for colorectal metastases. Arch Surg 2001; 136(10):1154–1157PubMedCrossRefGoogle Scholar
  10. 10.
    Yan TD, Padang R, Xia H, et al. Management of involved or close resection margins in 120 patients with colorectal liver metastases: edge cryotherapy can achieve long-term survival. Am J Surg 2006; 191(6):735–742PubMedCrossRefGoogle Scholar
  11. 11.
    Korpan NN. Hepatic cryosurgery for liver metastases. Long-term follow-up. Ann Surg 1997; 225(2):193–201Google Scholar
  12. 12.
    Heslin MJ, Medina-Franco H, Parker M, et al. Colorectal hepatic metastases: resection, local ablation, and hepatic artery infusion pump are associated with prolonged survival. Arch Surg 2001; 136(3):318–323PubMedCrossRefGoogle Scholar
  13. 13.
    Finlay IG, Seifert JK, Stewart GJ, Morris DL. Resection with cryotherapy of colorectal hepatic metastases has the same survival as hepatic resection alone. Eur J Surg Oncol 2000; 26(3):199–202PubMedCrossRefGoogle Scholar
  14. 14.
    Hewitt PM, Dwerryhouse SJ, Zhao J, Morris DL. Multiple bilobar liver metastases: cryotherapy for residual lesions after liver resection. J Surg Oncol 1998; 67(2):112–116PubMedCrossRefGoogle Scholar
  15. 15.
    Man K, Fan ST, Ng IO, et al. Prospective evaluation of Pringle maneuver in hepatectomy for liver tumors by a randomized study. Ann Surg 1997; 226(6):704–711PubMedCrossRefGoogle Scholar
  16. 16.
    Seifert JK, France MP, Zhao J, et al. Large volume hepatic freezing: association with significant release of the cytokines interleukin-6 and tumor necrosis factor a in a rat model. World J Surg 2002; 26(11):1333–1341PubMedCrossRefGoogle Scholar
  17. 17.
    Stewart GJ, Preketes A, Horton M, et al. Hepatic cryotherapy: double-freeze cycles achieve greater hepatocellular injury in man. Cryobiology 1995; 32(3):215–219PubMedCrossRefGoogle Scholar
  18. 18.
    Ravikumar TS, Steele G, Jr., Kane R, King V. Experimental and clinical observations on hepatic cryosurgery for colorectal metastases. Cancer Res 1991; 51:6323–6327PubMedGoogle Scholar
  19. 19.
    McCall JL, Jorgensen JO, Morris DL. Hepatic artery chemotherapy for colorectal liver metastases. Aust N Z J Surg 1995; 65(6):383–389PubMedGoogle Scholar
  20. 20.
    Yan TD, Padang R, Morris DL. Longterm results and prognostic indicators after cryotherapy and hepatic arterial chemotherapy with or without resection for colorectal liver metastases in 224 patients: longterm survival can be achieved in patients with multiple bilateral liver metastases. J Am Coll Surg 2006; 202(1):100–111PubMedCrossRefGoogle Scholar
  21. 21.
    Bakalakos EA, Kim JA, Young DC, Martin EW, Jr. Determinants of survival following hepatic resection for metastatic colorectal cancer. World J Surg 1998; 22(4):399–404PubMedCrossRefGoogle Scholar
  22. 22.
    Aldrighetti L, Castoldi R, Di Palo S, et al. [Prognostic factors for long-term outcome of hepatic resection for colorectal liver metastases]. Chir Ital 2005; 57(5):555–570PubMedGoogle Scholar
  23. 23.
    Tomizawa N, Ohwada S, Ogawa T, et al. Factors affecting the prognosis of anatomical liver resection for liver metastases from colorectal cancer. Hepatogastroenterology 2006; 53(67):89–93PubMedGoogle Scholar
  24. 24.
    Taylor M, Forster J, Langer B, et al. A study of prognostic factors for hepatic resection for colorectal metastases. Am J Surg 1997; 173(6):467–471PubMedCrossRefGoogle Scholar
  25. 25.
    Fong Y, Fortner J, Sun RL, et al. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 1999; 230(3):309–18; discussion 318–321PubMedCrossRefGoogle Scholar
  26. 26.
    Moroz P, Salama PR, Gray BN. Resecting large numbers of hepatic colorectal metastases. Aust N Z J Surg 2002; 72(1):5–10CrossRefGoogle Scholar
  27. 27.
    Wei AC, Greig PD, Grant D, et al. Survival after hepatic resection for colorectal metastases: a 10-year experience. Ann Surg Oncol 2006; 13(5):668–676PubMedCrossRefGoogle Scholar
  28. 28.
    Biasco G, Derenzini E, Grazi G, et al. Treatment of hepatic metastases from colorectal cancer: many doubts, some certainties. Cancer Treat Rev 2006; 32(3):214–228PubMedCrossRefGoogle Scholar
  29. 29.
    Charnsangavej C, Clary B, Fong Y, et al. Selection of patients for resection of hepatic colorectal metastases: expert consensus statement. Ann Surg Oncol 2006; 13(10):1261–1268PubMedCrossRefGoogle Scholar
  30. 30.
    Vauthey JN, Pawlik TM, Abdalla EK, et al. Is extended hepatectomy for hepatobiliary malignancy justified? Ann Surg 2004; 239(5):722–730PubMedCrossRefGoogle Scholar
  31. 31.
    Abdalla EK, Barnett CC, Doherty D, et al. Extended hepatectomy in patients with hepatobiliary malignancies with and without preoperative portal vein embolization. Arch Surg 2002; 137(6):675–680PubMedCrossRefGoogle Scholar
  32. 32.
    Jenkins LT, Millikan KW, Bines SD, et al. Hepatic resection for metastatic colorectal cancer. Am Surg 1997; 63(7):605–610PubMedGoogle Scholar
  33. 33.
    Milandri C, Calzolari F, Giampalma E, et al. Combined treatment of inoperable liver metastases from colorectal cancer. Tumori 2003; 89(Suppl 4):112–114Google Scholar
  34. 34.
    Abdalla EK, Adam R, Bilchik AJ, et al. Improving resectability of hepatic colorectal metastases: expert consensus statement. Ann Surg Oncol 2006; 13(10):1271–1280PubMedCrossRefGoogle Scholar
  35. 35.
    Golling M, Gog C, Woeste G, et al. Colorectal cancer liver metastases—neoadjuvant concepts for preoperative down-sizing. Zentralbl Chir 2006; 131(2):140–147PubMedCrossRefGoogle Scholar
  36. 36.
    Adam R, Delvart V, Pascal G, et al. Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg 2004; 240(4):644–657PubMedGoogle Scholar
  37. 37.
    Adam R, Pascal G, Castaing D, et al. Tumor progression while on chemotherapy: a contraindication to liver resection for multiple colorectal metastases? Ann Surg 2004; 240(6):1052–1061PubMedCrossRefGoogle Scholar
  38. 38.
    Pozzo C, Basso M, Cassano A, et al. Neoadjuvant treatment of unresectable liver disease with irinotecan and 5-fluorouracil plus folinic acid in colorectal cancer patients. Ann Oncol 2004; 15(6):933–939PubMedCrossRefGoogle Scholar
  39. 39.
    Adam R, Avisar E, Ariche A, et al. Five-year survival following hepatic resection after neoadjuvant therapy for nonresectable colorectal. Ann Surg Oncol 2001; 8(4):347–353PubMedCrossRefGoogle Scholar
  40. 40.
    Bismuth H, Adam R, Levi F, et al. Resection of nonresectable liver metastases from colorectal cancer after neoadjuvant chemotherapy. Ann Surg 1996; 224(4):509–520PubMedCrossRefGoogle Scholar
  41. 41.
    Capussotti L, Muratore A, Mulas MM, et al. Neoadjuvant chemotherapy and resection for initially irresectable colorectal liver metastases. Br J Surg 2006; 93(8):1001–1006PubMedCrossRefGoogle Scholar
  42. 42.
    Ross WB, Horton M, Bertolino P, Morris DL. Cryotherapy of liver tumours—a practical guide. HPB Surg 1995; 8(3):167–173PubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2007

Authors and Affiliations

  • Rui Niu
    • 1
  • Tristan D. Yan
    • 1
  • Jacqui C. Zhu
    • 1
  • Deborah Black
    • 2
  • Francis Chu
    • 1
  • David L. Morris
    • 1
  1. 1.Department of SurgeryUniversity of New South Wales, St George HospitalSydneyAustralia
  2. 2.School of Public Health and Community MedicineSydneyAustralia

Personalised recommendations