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Oncosurgery: a new reality in metastatic colorectal carcinoma.

Abstract
Surgery is the only curative option for the treatment of liver metastases from colorectal cancer. However, fewer than 25% of hepatic metastases are suitable for resection and as many as 70% of these will recur. A variety of factors have been identified as significant predictors of long-term survival following hepatic resection, and improved surgical techniques such as cryosurgery, radiofrequency ablation, portal vein embolization, and two-stage hepatectomy have been developed to overcome some of the negative factors that contribute to poor prognosis. Whereas adjunctive 5-fluorouracil-based chemotherapy has had little impact on outcome, the new platinum derivative oxaliplatin added to 5-fluorouracil plus leucovorin has improved time-dependent parameters of efficacy and successfully downstaged the disease in some patients with unresectable metastases. In a recent study in 389 such patients, 151 of which had liver-only metastases, 51% treated with oxaliplatin became resectable with some patients achieving a complete histologic response. In another series of 95 initially unresectable patients who became resectable after treatment with oxaliplatin-based therapy, 41% were still alive after 4.2 years, with 64% of these being recurrence-free. Postoperative chemotherapeutic regimes have also been developed to eliminate residual disease after surgery; however, the advantage of preoperative chemotherapy is the potential to achieve a conversion from unresectability to resectability of hepatic metastases from primary colorectal cancer.
AuthorsClare Topham, René Adam
JournalSeminars in oncology (Semin Oncol) Vol. 29 Issue 5 Suppl 15 Pg. 3-10 (Oct 2002) ISSN: 0093-7754 [Print] United States
PMID12422303 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)
CopyrightCopyright 2002, Elsevier Science (USA). All rights reserved.
Topics
  • Colorectal Neoplasms (drug therapy, pathology, surgery)
  • Combined Modality Therapy
  • Humans
  • Liver Neoplasms (drug therapy, secondary, surgery)
  • Prognosis
  • Survival Analysis

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