A pilot study of multimodality therapy for initially unresectable liver metastases from colorectal carcinoma: hepatic resection after hepatic arterial infusion chemotherapy and portal embolization

The prognosis of patients with unresectable liver metastases is poor, evenif hepatic arterial infusion chemotherapy (HAI) or systemic chemotherapy isadministered. A pilot study was performed to evaluate the feasibility andefficacy of multimodality therapy with hepatectomy after HAI and portalembolization for such patients. Eight patients with colorectal carcinomaand synchronous unresectable liver metastases underwent resection of theprimary tumor and placement of a pump, followed by HAI with 5-fluorouraciland mitomycin C. Owing to shrinkage of the liver metastases, two patientscould undergo extended right hepatic lobectomy after portal embolization,which was deemed to be essential to prevent post-operative hepatic failure.The median survival time of the eight patients was 30 months, with aresponse rate of 75%. Complications including sclerosing cholangitis andduodenal ulcer were observed in five patients (63%). Additional hepatectomycould be performed successfully after portal embolization without morbidityin two patients. These two patients are still alive more than 6 years afterinitiation of HAI and have been free of disease for more than 5 years afterhepatectomy. Hepatectomy after HAI and portal embolization is feasible andmay be an option to cure selected patients with initially unresectableliver metastases.