Hepatic Metastasectomy and Chemotherapy in Colorectal Cancer Treatment

Background: The best treatment for colorectal hepatic metastases is hepatic metastasectomy. The metastases resectability is associated with survival and should be considered in the therapeutic management in stage IV patients. Perioperative chemotherapy may be associated with major survival in these patients. Methods: Retrospective review of all patients who had hepatic metastasectomy at a central hospital from the years of 2007 to 2012. Survival analysis was performed by using the Kaplan-Meier method. Results: We have reviewed 139 cases, with a mean age of 62 years old [20-85]. 73% of patients had colon cancer and 27% rectal cancer. 14% of all patients didnt receive any chemotherapy. 2 patients receive neo-adjuvant chemotherapy, 58 patients had adjuvant chemotherapy and 46 had both neo-adjuvant and adjuvant chemotherapy. 32 patients responded to the neo-adjuvant chemotherapy. The neo-adjuvant chemotherapy scheme more often used was FOLFIRI with bevacizumab. From de 46 patients who had neo-adjuvant chemotherapy followed by surgery and adjuvant chemotherapy, 40 received the same chemotherapy scheme. FOLFOX was the most used scheme in adjuvant chemotherapy. 114 patients had R0 surgery. Today, 35% of patients have no evidence of disease, 27% are dead; 12% are receiving palliative chemotherapy, 8% are receiving adjuvant chemotherapy; 6% are in supportive care and 12% were lost from follow-up. The 1-year relapse free survival was 60% and the 5-year relapse free survival was 22%. The median relapse-free survival was 17 months [CI95% 13-21]. The 1-year global survival was 85% and the 5-year global survival was 39%. The median global survival was 38 months [CI95% 26-50]. Conclusion: In this review the hepatic metastases resections had low mortality and morbidity, so it should be considered in selected patients. The chemotherapy schemes were well tolerated permitting surgery and may have prolonged relapse-free intervals, or even cure.