Treatment strategies for hepatic metastasis from colorectal cancer |
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Authors: | Hiroshi Shimada Masao Nanko Shoichi Fujii Hidenobu Masui Shinji Togo Hideyuki Ike Akira Nakano and Shigeo Ohki |
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Institution: | (1) The Second Department of Surgery, Yokohama City University School of Medicine, Fukuura 3-9, 236 Kanazawaku, Yokohama, Japan |
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Abstract: | Hepatic micrometastases of the parenchyma adjacent to a macroscopic lesion were detected in 17 of 31 resected liver metastases.
Fifty-nine micrometastatic lesions were detected in total; 26 lesions were situated in the portal vein (PV), 22 in the central
vein (CV), 5 in the bile duct (BD), and 6 in the sinusoid (SS). A histological study confirmed the direct invasion of the
macrometastatic cancer cells into the adjacent PV, CV, BD, and SS. According to the tumor doubling time, the mean diameter
of the macrometastases in 19 remnant livers was calculated to have been 0.57±0.87 cm at the time of the primary resection.
The calculated diameter of 3 of these 19 macrometastases was found to be less than 0.01 cm, the minimum implantable size,
indicating that the cancer recurrence in these specimens may have developed from macroscopic metastatic lesions as a satellite,
and not from the primary tumor. In 13 patients who received doses of 5250 mg or more of 5 fluorouracil (FU) via the hepatic
artery, the cumulative disease-free rate 2 years postoperatively was 100%; this value was 47.6% in 11 patients who received
less than 5250 mg of 5 FU via the hepatic artery, and 0% in 39 patients who received no chemotherapy (P<0.005). These results suggest that anatomical hepatic resection for satellite lesions, combined with prophylactic hepatic
arterial chemotherapy for micrometastases, decreases the recurrence rate of hepatic metastases in the remnant liver. |
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Keywords: | hepatic metastasis from colorectal cancer hepatic resection micrometastasis chronology of hepatic metastases chemotherapy |
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