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. 1988 Jul;208(1):23–35. doi: 10.1097/00000658-198807000-00004

Treatment of cancer of the liver. Twenty years' experience with infusion and resection in 414 patients.

J S Stehlin Jr 1, P D de Ipolyi 1, P J Greeff 1, C J McGaff Jr 1, B R Davis 1, L McNary 1
PMCID: PMC1493568  PMID: 2839123

Abstract

The factors influencing survival for patients with cancer of the liver were studied by reviewing the records of 414 patients operated on in a private oncology practice. Approximately half (47%) had colorectal metastasis; 17% had metastatic breast carcinoma, 14% had malignant hepatoma, 5% had metastatic melanoma, and the remainder had a variety of primary cancers. Eighty-two per cent of all patients had advanced liver disease when first diagnosed. One quarter of the patients had some type of resection; the remainder had abdominal exploration plus insertion of an infusion catheter into the hepatic artery. The postoperative mortality rate after liver resection for 108 patients was 6.5%. After resection, the most important prognostic factor influencing survival was the presence or absence of extrahepatic metastases. When possible, resection was by far the best treatment available, and the best results were seen in patients who had resection of a solitary lesion. For advanced disease, when resection was not possible, intra-arterial chemotherapy, primarily with 5-fluorouracil (5-FU), was associated with response rates of 36% for colorectal cancer, 45% for breast cancer, 13% for hepatocellular cancer, 12% for melanoma, and 14% for metastases from other primary sites. The patients who responded to infusion lived longer than those who did not respond. For example, at 18 months, 26% of the responders with colorectal cancer were alive, as were 50% of the responders with breast cancer and 40% of the responders with hepatocellular cancer. In contrast, at 18 months, there were no survivors among the nonresponders with colorectal, breast, or hepatocellular cancer. For those patients treated solely by infusion chemotherapy, the extent of disease in the liver was the most reliable factor in predicting the length of survival. However, very few patients treated in this manner lived longer than 3 years.

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Selected References

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  1. Adson M. A., van Heerden J. A., Adson M. H., Wagner J. S., Ilstrup D. M. Resection of hepatic metastases from colorectal cancer. Arch Surg. 1984 Jun;119(6):647–651. doi: 10.1001/archsurg.1984.01390180015003. [DOI] [PubMed] [Google Scholar]
  2. Ansfield F. J., Ramirez G., Davis H. L., Jr, Wirtanen G. W., Johnson R. O., Bryan G. T., Manalo F. B., Borden E. C., Davis T. E., Esmili M. Further clinical studies with intrahepatic arterial infusion with 5-fluorouracil. Cancer. 1975 Dec;36(6 Suppl):2413–2417. doi: 10.1002/1097-0142(197512)36:6<2413::aid-cncr2820360621>3.0.co;2-3. [DOI] [PubMed] [Google Scholar]
  3. Ansfield F. J., Ramirez G., Skibba J. L., Bryan G. T., Davis H. L., Jr, Wirtanen G. W. Intrahepatic arterial infusion with 5-fluorouracil. Cancer. 1971 Nov;28(5):1147–1151. doi: 10.1002/1097-0142(1971)28:5<1147::aid-cncr2820280510>3.0.co;2-l. [DOI] [PubMed] [Google Scholar]
  4. August D. A., Sugarbaker P. H., Ottow R. T., Gianola F. J., Schneider P. D. Hepatic resection of colorectal metastases. Influence of clinical factors and adjuvant intraperitoneal 5-fluorouracil via Tenckhoff catheter on survival. Ann Surg. 1985 Feb;201(2):210–218. doi: 10.1097/00000658-198502000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Bengtsson G., Carlsson G., Hafström L., Jönsson P. E. Natural history of patients with untreated liver metastases from colorectal cancer. Am J Surg. 1981 May;141(5):586–589. doi: 10.1016/0002-9610(81)90057-x. [DOI] [PubMed] [Google Scholar]
  6. Burrows J. H., Talley R. W., Drake E. H., Tucker W. G. Infusion of fluorinated pyrimidines into hepatic artery for treatment of metastatic carcinoma of liver. Cancer. 1967 Nov;20(11):1886–1892. doi: 10.1002/1097-0142(196711)20:11<1886::aid-cncr2820201114>3.0.co;2-s. [DOI] [PubMed] [Google Scholar]
  7. Butler J., Attiyeh F. F., Daly J. M. Hepatic resection for metastases of the colon and rectum. Surg Gynecol Obstet. 1986 Feb;162(2):109–113. [PubMed] [Google Scholar]
  8. Cady B., McDermott W. V. Major hepatic resection for metachronous metastases from colon cancer. Ann Surg. 1985 Feb;201(2):204–209. doi: 10.1097/00000658-198502000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Cady B., Oberfield R. A. Regional infusion chemotherapy of hepatic metastases from carcinoma of the colon. Am J Surg. 1974 Feb;127(2):220–227. doi: 10.1016/0002-9610(74)90161-5. [DOI] [PubMed] [Google Scholar]
  10. Carter S. K. Editorial: Large-bowel cancer-The current status of treatment. J Natl Cancer Inst. 1976 Jan;56(1):3–10. doi: 10.1093/jnci/56.1.3. [DOI] [PubMed] [Google Scholar]
  11. Cohen A. M., Kaufman S. D., Wood W. C., Greenfield A. J. Regional hepatic chemotherapy using an implantable drug infusion pump. Am J Surg. 1983 Apr;145(4):529–533. doi: 10.1016/0002-9610(83)90053-3. [DOI] [PubMed] [Google Scholar]
  12. Cohen A. M., Schaeffer N., Higgins J. Treatment of metastatic colorectal cancer with hepatic artery combination chemotherapy. Cancer. 1986 Mar 15;57(6):1115–1117. doi: 10.1002/1097-0142(19860315)57:6<1115::aid-cncr2820570609>3.0.co;2-p. [DOI] [PubMed] [Google Scholar]
  13. Fortner J. G., Silva J. S., Golbey R. B., Cox E. B., Maclean B. J. Multivariate analysis of a personal series of 247 consecutive patients with liver metastases from colorectal cancer. I. Treatment by hepatic resection. Ann Surg. 1984 Mar;199(3):306–316. doi: 10.1097/00000658-198403000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Foster J. H. Survival after liver resection for cancer. Cancer. 1970 Sep;26(3):493–502. doi: 10.1002/1097-0142(197009)26:3<493::aid-cncr2820260302>3.0.co;2-7. [DOI] [PubMed] [Google Scholar]
  15. Foster J. H. Survival after liver resection for secondary tumors. Am J Surg. 1978 Mar;135(3):389–394. doi: 10.1016/0002-9610(78)90072-7. [DOI] [PubMed] [Google Scholar]
  16. Grage T. B., Vassilopoulos P. P., Shingleton W. W., Jubert A. V., Elias E. G., Aust J. B., Moss S. E. Results of a prospective randomized study of hepatic artery infusion with 5-fluorouracil versus intravenous 5-fluorouracil in patients with hepatic metastases from colorectal cancer: A Central Oncology Group study. Surgery. 1979 Oct;86(4):550–555. [PubMed] [Google Scholar]
  17. Hohn D. C., Rayner A. A., Economou J. S., Ignoffo R. J., Lewis B. J., Stagg R. J. Toxicities and complications of implanted pump hepatic arterial and intravenous floxuridine infusion. Cancer. 1986 Feb 1;57(3):465–470. doi: 10.1002/1097-0142(19860201)57:3<465::aid-cncr2820570311>3.0.co;2-s. [DOI] [PubMed] [Google Scholar]
  18. Hughes K. S., Simon R., Songhorabodi S., Adson M. A., Ilstrup D. M., Fortner J. G., Maclean B. J., Foster J. H., Daly J. M., Fitzherbert D. Resection of the liver for colorectal carcinoma metastases: a multi-institutional study of patterns of recurrence. Surgery. 1986 Aug;100(2):278–284. [PubMed] [Google Scholar]
  19. Kemeny M. M., Goldberg D., Beatty J. D., Blayney D., Browning S., Doroshow J., Ganteaume L., Hill R. L., Kokal W. A., Riihimaki D. U. Results of a prospective randomized trial of continuous regional chemotherapy and hepatic resection as treatment of hepatic metastases from colorectal primaries. Cancer. 1986 Feb 1;57(3):492–498. doi: 10.1002/1097-0142(19860201)57:3<492::aid-cncr2820570315>3.0.co;2-m. [DOI] [PubMed] [Google Scholar]
  20. Kemeny N. The systemic chemotherapy of hepatic metastases. Semin Oncol. 1983 Jun;10(2):148–158. [PubMed] [Google Scholar]
  21. Logan S. E., Meier S. J., Ramming K. P., Morton D. L., Longmire W. P., Jr Hepatic resection of metastatic colorectal carcinoma: a ten-year experience. Arch Surg. 1982 Jan;117(1):25–28. doi: 10.1001/archsurg.1982.01380250015003. [DOI] [PubMed] [Google Scholar]
  22. Niederhuber J. E., Ensminger W., Gyves J., Thrall J., Walker S., Cozzi E. Regional chemotherapy of colorectal cancer metastatic to the liver. Cancer. 1984 Mar 15;53(6):1336–1343. doi: 10.1002/1097-0142(19840315)53:6<1336::aid-cncr2820530620>3.0.co;2-o. [DOI] [PubMed] [Google Scholar]
  23. Patt Y. Z., Boddie A. W., Jr, Charnsangavej C., Ajani J. A., Wallace S., Soski M., Claghorn L., Mavligit G. M. Hepatic arterial infusion with floxuridine and cisplatin: overriding importance of antitumor effect versus degree of tumor burden as determinants of survival among patients with colorectal cancer. J Clin Oncol. 1986 Sep;4(9):1356–1364. doi: 10.1200/JCO.1986.4.9.1356. [DOI] [PubMed] [Google Scholar]
  24. Patt Y. Z., McBride C. M., Ames F. C., Claghorn L. J., Cleary K. R., Boddie A. W., Charnsangavej C., Mavligit G. M. Adjuvant perioperative hepatic arterial mitomycin C and floxuridine combined with surgical resection of metastatic colorectal cancer in the liver. Cancer. 1987 Mar 1;59(5):867–873. doi: 10.1002/1097-0142(19870301)59:5<867::aid-cncr2820590502>3.0.co;2-j. [DOI] [PubMed] [Google Scholar]
  25. Ramming K. P., O'Toole K. The use of the implantable chemoinfusion pump in the treatment of hepatic metastases of colorectal cancer. Arch Surg. 1986 Dec;121(12):1440–1444. doi: 10.1001/archsurg.1986.01400120090015. [DOI] [PubMed] [Google Scholar]
  26. STEHLIN J. S., Jr, CLARK R. L. Experiences with regional chemotherapy. Perfusions and intra-arterial infusion. Arch Surg. 1962 Jul;85:84–94. doi: 10.1001/archsurg.1962.01310010088013. [DOI] [PubMed] [Google Scholar]
  27. Starzl T. E., Koep L. J., Weil R., 3rd, Lilly J. R., Putnam C. W., Aldrete J. A. Right trisegmentectomy for hepatic neoplasms. Surg Gynecol Obstet. 1980 Feb;150(2):208–214. [PMC free article] [PubMed] [Google Scholar]
  28. Stehlin J. S., Jr, Hafström L., Greeff P. J. Experience with infusion and resection in cancer of the liver. Surg Gynecol Obstet. 1974 Jun;138(6):855–863. [PubMed] [Google Scholar]
  29. Stehlin J. S., Jr Hyperthermic perfusion with chemotherapy for cancers of the extremities. Surg Gynecol Obstet. 1969 Aug;129(2):305–308. [PubMed] [Google Scholar]
  30. Stehlin J. S., Jr Perfusion for melanoma of the extremities: 6 and one half-years' experience with 221 cases. Proc Natl Cancer Conf. 1964;5:525–531. [PubMed] [Google Scholar]
  31. Thompson H. H., Tompkins R. K., Longmire W. P., Jr Major hepatic resection. A 25-year experience. Ann Surg. 1983 Apr;197(4):375–388. doi: 10.1097/00000658-198304000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Wanebo H. J., Semoglou C., Attiyeh F., Stearns M. J., Jr Surgical management of patients with primary operable colorectal cancer and synchronous liver metastases. Am J Surg. 1978 Jan;135(1):81–85. doi: 10.1016/0002-9610(78)90014-4. [DOI] [PubMed] [Google Scholar]
  33. Wilson S. M., Adson M. A. Surgical treatment of hepatic metastases from colorectal cancers. Arch Surg. 1976 Apr;111(4):330–334. doi: 10.1001/archsurg.1976.01360220026004. [DOI] [PubMed] [Google Scholar]

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