The impact of synchronous liver resection on the risk of anastomotic leakage following elective colorectal resection. A propensity score match analysis on behalf of the iCral study group

Introductionhow best to manage patients with colorectal cancer and synchronous liver metastasis is still controversial, with specific concerns of increased risk of postoperative complications following combined resection. We aimed at analyzing the influence of combined liver resection on the risk of anastomotic leak (AL) following colorectal resection.Methodswe reviewed the iCral prospectively maintained database to compare the relative risk of AL of patients undergoing colorectal resection for cancer to that of patients receiving simultaneous liver and colorectal resection for cancer with isolated hepatic metastases. The incidence of AL was the primary outcome of the analysis. Perioperative details and postoperative complications were also appraised.Resultsout of a total of 996 patients who underwent colorectal resection for cancer, 206 receiving isolated colorectal resection were compared with a matched group of 53 patients undergoing simultaneous liver and colorectal resection. Combined surgery had greater operative time and resulted in longer postoperative hospitalization compared to colorectal resection alone. The proportion of overall morbidity following combined resection was significantly higher than after isolated colorectal resection (56.6% vs. 37.9%, p = 0.021). Overall, the two groups of patients did not differ neither on the rate of major postoperative complications, nor in terms of AL (9.4% vs. 6.3%, p = 0.381). At specific multivariate analysis, the duration of surgery was the only risk factor independently associated with the likelihood of AL.Conclusionscombining hepatic with colorectal resection for the treatment of synchronous liver metastasis from colorectal cancer does not increase significantly the incidence of AL.     

Cytoreductive surgery with placement of intra-arterial infusion pump for unresectable liver tumors

The initial results are discussed of treatment protocol for unresectable liver tumors using combinations of cytoreductive surgery (resection and/or radiofrequency ablation (RFA)) and hepatic artery infusion pump (HAIP) placement to be followed by chemotherapy. Out of 14 patients with unresectable liver tumors (2003-2006), 12 were operated on for colorectal metastases, 1 - hepatocellular carcinoma, and 1 metastatic carcinoid. Seven patients received RFA, 4 - resection+RFA+ HAIP, and 3 - resection+ HAIP. All patients were given HAIP postoperatively. No grave complications were reported. Mean follow-up was 14 months (6-38) with an average of 6 chemotherapy cycles (2-12) per patient. At present, 8 patients have survived 6-38 months and continue to receive regional chemotherapy; overall 1- or 2- year survival is 85 and 57%, respectively. Six patients died from tumor progression within 4-21 months.     

The extent of resection influences outcome following hepatectomy for colorectal liver metastases.

BACKGROUND: The acceptable indications for liver resection in patients with colorectal metastases have increased significantly in the last decade. It is thus becoming more difficult to ascertain the limitations for selection as the boundaries have been greatly extended. This has resulted in not only more extensive resections, but more atypical and bilobar resections. The aim of this study was to compare the outcome of patients undergoing different extent of liver resection in a specialist unit. METHODS: All patients undergoing liver resection for colorectal metastases at the Royal Infirmary of Edinburgh between October 1988 and April 2001 were reviewed. Patients were allocated into one of three groups: standard group, extended group, and segmental group. Patient information was collected from a prospectively completed database. RESULTS: One hundred and thirty-seven patients had liver resections for colorectal metastases during the study period. There were 69 standard hepatectomies, 41 extended resections and 27 segmental resections. CEA level was significantly lower in the segmental group(p = 0.012). There was a significant difference between the groups in terms of median operating time (p < 0.0001, Kruskal-Wallis test), operative blood loss (p = 0.006, Kruskal-Wallis test) and post-operative stay ( p = 0.036, Kruskal-Wallis test). Major post-operative complications were similar between standard and extended resections but less following segmental resection (p = 0.050. Predicted median survival was 51 months following standard resection, 23 months following extended resection and 59 months after segmental resection ( p = 0.037, log rank test), however, there was no difference between the three groups for actual 5-year survival (p = 0.662, Pearson chi-square test). CONCLUSION: Morbidity and mortality rates were comparable with other previous studies as was overall survival, although survival in patients undergoing extended resections was reduced. There was an acceptable level of morbidity and mortality for all three groups. Patients undergoing segmental resection had fewer complications, shorter length of stay, and the longest median survival suggesting adequate oncological clearance. Segmental resection has a role for favourably placed tumour deposits if oncological clearance can be ensured. Extended liver resections have a role for selected patients with bilobar colorectal metastases or large solitary deposits close to the hepatic vein confluence.     

Quantification of risk of a positive (R1) resection margin following hepatic resection for metastatic colorectal cancer: an aid to clinical decision-making

BACKGROUND AND AIMS: Margin involvement following liver resection for colorectal cancer is associated with early disease recurrence and shorter long-term survival. This study aimed to develop a predictive index for quantifying the likelihood of a positive resection margin (R1) for patients undergoing hepatic resection for metastatic colorectal cancer. METHODS: Clinical, pathological and complete follow-up data were prospectively collected from 1005 consecutive liver resections performed in 929 patients for colorectal liver metastases with curative intent at a single centre between 1987 and 2005. Ninety-four resections in 81 patients with extra-hepatic disease were excluded, leaving 911 resections (844 primary and 67 repeat) in 848 patients for analysis. Multivariate logistic regression was used to identify independent predictors of margin involvement and from the beta-coefficients generated, develop a predictive model that was validated using measures of discrimination and calibration. RESULTS: There were 80 (8.8%) R1 resections, with a 5-year cancer-specific survival for R0 and R1 hepatic resections of 39.7% and 17.8%, respectively; p<0.001. On multivariate analysis, five risk factors were found to be independent predictors of an R1 resection: non-anatomical resection vs. anatomical resection (odds ratio (OR)=4.3, p=0.001), >3 hepatic metastases involving >50% of the liver vs. <3 metastases (OR=4.0, p<0.001); bilobar vs. unilobar disease (OR=2.9, p<0.001); repeat vs. primary hepatic resection (OR=3.1, p=0.006); abnormal vs. normal pre-operative liver function tests (OR=1.6, p=0.044). These five factors were used to develop a predictive model, which when tested, fitted the data well, with an area under the receiver operating characteristic curve of 78.1% (S.E.=2.7%). CONCLUSIONS: This study describes an accurate model for quantifying the risk of a positive margin following hepatic resection for liver metastases. It may be used pre-operatively by multi-disciplinary teams to identify patients who may benefit from neoadjuvant therapy prior to liver surgery, thus minimizing the risk of a positive resection margin.     

Randomized trial of preoperative administration of oral pregabalin for postoperative analgesia in patients scheduled for radiofrequency ablation of focal lesions in the liver

Purpose: The aim of this study was to evaluate the effect of preoperative pregabalin on postoperative analgesia in patients undergoing radiofrequency ablation (RFA) of hepatic focal lesions (HFLs).

Methods: This randomised controlled study was carried out on 70 adult patients for whom RFA was indicated to treat hepatocellular carcinoma. They were randomised into two groups: Group I: 35 patients who were given a placebo before the procedure and Group II: 35 patients who were given 150?mg of oral pregabalin one hour before the procedure. The primary outcome was the analgesic effect in the form of postoperative pain severity and the need for opioid analgesics.

Results: In the immediate postoperative period there was no significant difference between the two groups on pain assessment by the visual analogue pain scale (VAS Pain; p?=?0.84). However, the medians of Group II VAS Pain were significantly (p?p?p?=?0.02, 0.01 and 0.01, respectively).

Conclusion: Pre-emptive oral pregabalin is safe and effective for postoperative analgesia in patients scheduled for radiofrequency ablation of focal lesions in liver.     

Pattern of carcinoembryonic antigen drop after laparoscopic radiofrequency ablation of liver metastasis from colorectal carcinoma

BACKGROUND: Laparoscopic radiofrequency ablation (RFA) is being increasingly used for local control of hepatic metastasis from colorectal carcinoma (CRC). After surgical resection of colorectal liver metastasis, carcinoembryonic antigen (CEA) values fall within 2 weeks, making this a useful parameter to follow shortly after surgery. Little is known, however, about the expected pattern of the CEA drop after RFA. METHODS: From September 1998 to October 2002, RFA to CRC liver metastasis was performed on 144 patients. A subset of 17 patients were studied who had no evidence of extrahepatic disease preoperatively, had all detectable tumor ablated intraoperatively, and who on long-term follow-up (up to 15 months) had no evidence of recurrent disease. Serum CEA was determined preoperatively, on the first postoperative day, at 1 week, and every 3 months afterwards. A computed tomography (CT) scan of the abdomen and pelvis was obtained every 3 months postoperatively. RESULTS: Ten (58.8%) patients showed an increase in CEA on postoperative Day 1, averaging 38.3% compared with the preoperative value. CEA then fell to 50% of the preoperative value, on average, on Day 7 postoperatively and only reached its nadir at 3 months. CONCLUSIONS: Unlike resection patients, those undergoing ablation show an initial rise in CEA, probably due to release from the ablated tissue. Although heating of RFA would be expected to destroy CEA, the initial rise and slow drop postoperatively argue for a release of immunoreactive CEA from the ablated zone. This slow decline in CEA indicates that several months should pass before assessing the extent of potential residual disease.     

Strategies for the treatment of synchronous liver metastasis.

AIM: Observe the outcomes after complete simultaneous or delayed resection of synchronous liver metastasis (SLM) from colorectal cancer (CRC). METHODS: From 1994 to 2005, 119 patients were diagnosed with CRC and SLM; 57 patients had simultaneous resection (group I) and 62 patients had staged resection (group II). Perioperative chemotherapy was considered completed if all expected cycle were administrated. RESULTS: Overall survival rates of group I-group II at 1, 3 and 5 years were respectively 91%-93% (p=0,3), 59%-57% (p=0,09) and 32%-25% (p=0,06). The median survival time of group I-group II were respectively 46 months-40 months (p=0,07). There was no statistical difference on survival regarding location of metastasis (p=0,09) or primary tumor location (p=0,2). Patients with simultaneous or staged resection receiving optimal treatment (R0 liver surgery and complete chemotherapy) were respectively 89% and 67% (p=0,04). Twenty three patients developed isolated liver recurrence with higher frequency in staged patients (26% vs 9% p=0,03) without impairment of survival. CONCLUSIONS: Because of postoperative morbidity and prolonged tiring treatment, many patients having staged resection were under treated. However we did not observe statistical difference on survival but we supported that simultaneous resection has to be prefer to achieve an optimal treatment. Lung and bone metastasis are the new challenge for oncologists.     

Radiofrequency ablation of liver metastases from colorectal carcinoma.

BACKGROUND: Most patients with colorectal carcinoma will develop liver metastases. Radiofrequency ablation (RFA) has been utilized in metastatic CRC to help improve the survival gap between resectable and unresectable tumor. METHODS: The current use of RFA in selected patient populations is reviewed. RESULTS: RFA provides a survival benefit in patients with unresectable hepatic metastases from CRC compared with chemotherapy alone. It offers effective local tumor destruction in appropriately selected lesions and minimizes the morbidity and mortality of an open resection. Common complications are abdominal bleeding (1.6%), abdominal infection (1.1%), and injury to the biliary tree (1.0%). Mortality ranges from 0% to 0.5%. CONCLUSIONS: Trials are underway to compare chemotherapy plus local ablation to chemotherapy alone. RFA is a tool that should be utilized by experienced individuals to achieve optimal oncologic outcomes.     

Microwave Ablation Compared with Radiofrequency Ablation for The Treatment of Liver Cancer: a Systematic Review and Meta-analysis

BackgroundGuidelines have reported that although microwave ablation (MWA) has potential advantages over radiofrequency ablation (RFA), superiority in efficacy and safety remain unclear. Aim of the study is to compare MWA with RFA in the treatment of liver cancer.MethodsMeta-analysis was conducted according to the PRISMA guidelines for studies published from 2010 onwards. A random-effects model was used for the meta-analyses. Complete ablation (CA), local tumor progression (LTP), intrahepatic distant recurrence (IDR), and complications were analyzed.ResultsFour randomized trials and 11 observational studies with a total of 2,169 patients met the inclusion criteria. Although overall analysis showed no significant difference in LTP between MWA and RFA, subgroup analysis including randomized trials for patients with hepatocellular cancer (HCC) demonstrated statistically decreased rates of LTP in favor of MWA (OR, 0.40; 95% CI, 0.18–0.92; p = 0.03). No significant differences were found between the two procedures in CA, IDR, complications, and tumor diameter less or larger than 3 cm.ConclusionsMWA showed promising results and demonstrated better oncological outcomes in terms of LTP compared to RFA in patients with HCC. MWA can be utilized as the ablation method of choice in patients with HCC.Key words: liver, carcinoma hepatocellular, liver neoplasms, radiofrequency ablation, microwaves     

Neoadjuvant chemotherapy does not increase postoperative complication rate after resection of colorectal liver metastases.

BACKGROUND: This paper discusses, whether neoadjuvant chemotherapy has an impact on the rate of postoperative complications after primary resection of liver metastases from colorectal carcinoma. METHODS: Of 183 patients 64 were studied. The patients were subdivided into two matched groups of 32 patients each-prior neoadjuvant chemotherapy (CT-group) vs. (control-group, primary resection). RESULTS: There were no postoperative complications in 24 patients of the control group (75%) and 26 patients of the CT-group (81%). Following prior chemotherapy, no major complications such as liver failure were observed, even after extended resections. CONCLUSION: Neoadjuvant chemotherapy prior to surgical resection of colorectal liver metastases does not result in an increase of postoperative morbidity and mortality.     

伴有同时性肝转移结直肠癌的外科治疗

目的探讨伴有同时性肝转移结直肠癌的外科治疗及其适应证。方法收集经外科手术治疗的116例伴有同时性肝转移的结直肠癌患者的临床资料,进行生存分析,并通过单因素分析和Cox比例风险模型多因素分析确定患者预后的影响因素。结果116例患者均行结直肠癌原发肿瘤切除,18例行同期肝转移瘤切除。围手术期死亡2例(1.7%),术后发生并发症者17例(14.7%)。全组患者5年生存率为14.29%,肝转移瘤切除患者5年生存率为32.12%。多因素分析显示,肝转移瘤切除、腹腔扩散、介入治疗和全身化疗是影响预后的最主要因素。结论伴有同时性肝转移的结直肠癌患者,选择外科手术切除肿瘤病灶,并辅助综合治疗可延长患者的生存时间。     

同时性结直肠癌肝转移患者治疗策略探讨

背景与目的:肝切除术是治疗同时性结直肠癌肝转移获得长期生存的希望.但如何选择肝切除术的手术时机,存在较大的争议,本研究探讨同时性结直肠癌肝转移的手术治疗策略.方法:选择上海东方肝胆外科医院和上海长海医院1995年1月至2005年12月收治的经手术治疗的83例同时性结直肠癌肝转移患者,其中37例行一期手术,46例行分期手术,比较两组手术并发症、死亡率、术中失血量、住院时间、生存率、中位生存期、无瘤生存期及肝转移癌复发率.结果:一期手术组手术并发症发生率为24.3%,分期手术组为19.6%(P=0.601).两组均没有手术死亡.一期手术组术中平均失血量为462 mL,分期手术组为574mL(P=0-312).一期手术组平均住院时间为19 d,分期手术组为36 d(P=0.001).一期手术组l、3、5年生存率分别为86.5%、54.1%和27.0%,分期手术组分别为89.1%(P-0.713)、52.2%(P=0.865)和23.9%(P=0.746).一期手术组中位生存期为40个月,分期手术组为37个月(丹0.075).一期手术组中位无瘤生存期为12个月,分期手术组为11个月(P=0.532).一期手术组肝转移癌复发率为35.1%,分期手术组为30.4% (P=0.650).结论:同时性结直肠癌肝转移患者有选择的一期手术切除原发病灶及肝转移病灶是合理的.     

Propensity score matching demonstrates similar results for radiofrequency ablation compared to surgical resection in colorectal liver metastases

PurposeMinimally invasive ablative treatments, such as radiofrequency ablation (RFA), are increasingly used in the curative treatment of patients with colorectal liver metastases (CRLM). Selection bias plays an important role in the evaluation of early and late results between RFA and surgery. The purpose of this study was to evaluate recurrences and oncological survival following these two treatment modalities using single pair propensity score matching.MethodsBetween 2000 and 2018, patients curatively treated for CRLM were included in a multicentre database. Patients were excluded when receiving two-staged treatment, synchronous treatment with primary tumor or combination of modalities. Propensity score matching was used to minimize influence of known covariates, i.e., age, ASA, FONG CRS, location and T-stage of the primary tumor.ResultsBefore matching, the RFA group contained 39 patients and the surgery group 982 patients, after matching both groups contained 36 patients. After matching, mean age was 69 years (53–86) for RFA and 68 (50–86) for surgery, with a mean tumor size of respectively 2.5 cm (0.8–6.5) and 3.4 cm (1–7.5). Both groups showed similar complication rate according to Clavien-Dindo (17vs.33%; p = 0.18), recurrence rate (58vs.64%; p = 0.09) without significant differences in 5-year DFS and OS (RFA compared to surgery respectively 25vs.37%; p = 0.09 and 42vs.53%; p = 0.09).ConclusionAfter propensity score matching, RFA showed lower complications and similar oncological survival compared to surgical resection. In patients who are suboptimal candidates for surgery, RFA seems to be a good and safe alternative.     

腹腔镜下同期治疗结直肠癌并肝转移的临床观察

目的 探讨腹腔镜下行结直肠癌切除术同时处理合并肝转移癌的疗效。方法 对32例结直肠癌合并肝转移患者行腹腔镜下结直肠癌切除手术,同时利用腹腔镜直视下切除或射频消融等方法治疗肝转移癌。结果 32例患者手术过程顺利,手术时间为220～384min,平均280min,出血量为240～1300ml,无严重并发症发生。随访6～32月,18例存活,7例死于肺、脑或腹腔转移,3例死于复发,2例死于脑出血,2例死于心肌梗塞。结论 利用腹腔镜直视下治疗结直肠癌并肝转移安全有效,可避免二期手术的创伤。     

超声引导下肝癌射频消融术的疗效及其对患者生命质量的影响

目的：观察超声引导下肝癌射频消融术的疗效及其对患者生命质量的影响.方法：92例肝癌143个病灶行超声引导下射频消融术治疗.于围手术期给予患者综合护理,分别于术前、术后进行血清学和影像学检查,并应用肝癌生命质量量表测定生命质量.结果：97.9％的肝癌患者RFA术后症状有不同程度的改善,未出现严重并发症.转氨酶出现一过性升高,并于术后一周恢复,AFP水平较术前明显下降.肝癌病灶完全消融率71.3％,不全消融率28.7％.术后1年、2年的总生存率分别为90.7％、73.2％.结论：RFA是一种有效、安全、副作用小的肝癌非手术治疗手段,能够提高患者生命质量.围手术期的综合护理对于RFA顺利实施及术后的康复具有重要作用.     

Enlargement of thermal ablation zone by the combination of ethanol injection and radiofrequency ablation in excised bovine liver

The efficacy of radiofrequency ablation (RFA) and RFA with concurrent ethanol injection (EI-RFA) was compared. RFA (3-cm-electrode) was applied to bovine liver using three types of RFA equipment; Radionics, RITA and Radio Therapeutics Corporation (RTC). For EI-RFA, 5 ml of 99.5% ethanol was injected around the electrode. A total number of 40 RFA and EI-RFA treatments were performed. We compared RFA with EI-RFA by examining the size, shape of ablation zone, treatment time, power, and needle tip temperature. Liver specimens were examined for pathological changes. EI-RFA produced a larger zone of ablation than RFA alone using Radionics and RITA (Radionics, 35.3+/-7.4 cm(3) vs 23.2+/-7.7 cm(3), p<0.05; RITA, 30.7+/-10.3 cm(3) vs 19.7+/-4.7 cm(3), p<0.05), corresponding to shortest diameters of coagulation zone (Radionics, 3.7+/-0.4 cm vs 3.0+/-0.4 cm, p<0.05; RITA, 3.8+/-0.4 cm vs 3.1+/-0.3 cm, p<0.01). However, a larger ablation zone was not seen with the RTC device. The ablated volume per energy and the ablated volume per current density administered were greater with EI-RFA than with RFA using Radionics (p<0.05). The shape of the ablated zone changed from ellipsoid to spherical with EI-RFA using Radionics. No pathological differences between RFA and EI-RFA samples were detected. For a given amount of energy and current administered, ethanol injection caused a better ablation effect, in terms of the size and shape of the ablated zone, than RFA with Radionics and RITA equipment.     

大肝癌患者行 TACE 序贯射频消融的疗效及复发因素

目的：探讨经导管肝动脉化疗栓塞（TACE）联合序贯射频消融术（RFA）治疗大肝癌患者的疗效及复发因素。方法：选取我院2013年1月－2015年1月肿瘤外科中晚期原发性大肝癌患者110例并分为肝动脉化疗栓塞组（TACE 组）与肝动脉化疗栓塞联合序贯经皮射频消融术组（TACE ＋RFA 组）各55例,TACE 组患者行一次或多次单一肝动脉化疗治疗;TACE ＋RFA 组在肝动脉化疗治疗结束后1～2周再行序贯经皮射频消融术治疗。结果：TACE 组与 TACE ＋RFA 组总有效率分别为63．64％（35／55）、94．54％（52／55）。TACE ＋RFA 组1年生存率为72．7％（40／55）,2年生存率为20．0％（11／55）,而 TACE 组分别为56．36％（31／55）、7．27％（4／55）。Log －rank 检验结果显示肿瘤数量、分期、血清甲胎蛋白水平等为大肝癌患者预后的因素,与患者预后有一定关系。结论：经导管肝动脉化疗栓塞（TACE）联合经皮射频消融术（RFA）治疗原发性中晚期大肝癌可以有效提高患者生存率,延长患者的生存期。肿瘤数量、直径、分期等是影响患者复发的危险因素。     

Radiofrequency ablation permits an effective treatment for colorectal liver metastasis.

BACKGROUND: Radiofrequency ablation (RFA) has become an important adjunct to modern liver surgery. However, scant knowledge on long-term outcome of RFA for colorectal liver metastasis is available, nowadays. METHODS: This is a prospective clinical study of patients with liver metastasis of colorectal cancer who were treated by RFA between April 1, 1998, and November 30, 2004. Forty-seven patients with 147 liver metastases were treated with RFA in a total of 70 interventions. A metastasis resection was not feasible in 80% of the interventions. All the patients were followed up at regular intervals with contrast-enhanced computed tomography (CT) and laboratory tests including carcinoembryonic antigen (CEA). RESULTS: No RFA-related mortality occurred. The median follow-up time after the diagnosis of liver metastasis was 33 months. The RFA-related morbidity was 7%. After the RFA, the expected median overall survival rate is, to date, 39 months. Overall survival rates at 1, 2 and 3 years were 88%, 80% and 57%, respectively. Local recurrence rates reached 8.8% overall and 1.6% for metastasis smaller than 3cm in diameter. No local recurrence occurred for metastasis smaller than 3cm in diameter if treated with the newest RFA device. CONCLUSIONS: Excellent local tumour control was achieved with radiofrequency ablation of small liver metastasis. The expected overall survival rate of patients with RFA for unresectable or non-resected colorectal liver metastasis improved in comparison with the survival rate reported following the natural course (best supportive care) or chemotherapy. The low local recurrence rate of metastases of less than 3cm challenges the results obtained by the more invasive treatment of conventional liver surgery.     

Radiofrequency ablation for liver metastasis from gastric cancer

Aims

Several studies have reported the benefit of hepatic resection for metastatic tumor from gastric cancer. However, the value of treatment with radiofrequency ablation (RFA) has not been clearly defined.

Methods

Between Jan 2002 and Dec 2007, 21 patients with primary gastric cancer were diagnosed with synchronous or metachronous liver metastases. All patients were treated with RFA, and the complication, survival, and recurrence rates were assessed.

Results

The postoperative complication rate was 5% (1/21), with no mortality. The median actuarial survival time was 14 months. The 1-yr, 2-yr, 3-yr, and 5-yr survival rates after RFA were 70%, 11%, 5%, and 3%, respectively. With a median follow-up time of 19 months, local recurrence at the RFA site was 19% (4/21). Solitary metastasis had significantly longer survival than multiple lesions after RFA (22 vs 10 months, P = 0.004).

Conclusions

RFA provides a minimally invasive and safe modality of treatment patients with liver metastasis from gastric cancer. Patients with solitary liver lesion were considered appropriate candidates for RFA.     

Evaluation of prophylactic hepatic arterial infusion chemotherapy after curative hepatectomy for metastatic colorectal cancer

We evaluated the effect of hepatic arterial infusion (HAI) chemotherapy after curative resection of liver metastases of colorectal cancer. A total of 161 patients underwent curative resection of liver metastases. Among them, 50 patients underwent HAI of 5-FU, and 111 patients had no HAI therapy. The 50% disease-free survival time (50% DFS) was 758 days and 342 days in the HAI group and the non-HAI group (logrank test, p<0.01), and the 50% overall survival time (50% OS) was 978 days versus 730 days (p<0.05), respectively. Among the 71 patients with multiple resectable metastases (H2 or H3), the HAI group had a significantly superior 50% DFS. HAI therapy seems to be an effective form of adjuvant chemotherapy after hepatic resection of metastatic colorectal cancer.