Resection Benefits High-Risk Liver Met Patients

SAN DIEGO—Historically, 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 Chicago’s 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 survival rate.

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. “We’re not changing the pace of the disease, but we are prolonging survival, because patients are not dying from their liver disease.”