Unresectable hepatic metastases from carcinoma of the colon and rectum

To alter the dismal prognosis of multiple unresectable metastases to the liver from carcinoma of the colon and rectum, 30 patients underwent hepatic dearterialization (ligation of the hepatic artery, transection of hepatic ligaments and cholecystectomy) and distal hepatic artery cannulation with prolonged infusion chemotherapy by a portable infusion pump followed by systemic intravenous chemotherapy. Involvement of the liver by carcinoma was less than 50 per cent in 16 and more than 50 per cent in 14 patients. The results of follow-up examinations, LFT, CEA and CT scan studies showed more than 50 per cent regression of the tumor and a decrease in alkaline phosphatase values and CEA in 29 patients (97 per cent); six had complete regression of tumor. The duration of response ranged from five to 39 months with the median of 17 or more months. The results of sequential LFT showed immediate increase in liver enzymes with return to normal in seven to 14 days. The mean CEA value decreased by 69 per cent within the first week and further decreased by 88 per cent in two months at the end of infusion chemotherapy. The over-all and adjusted survival rates from diagnosis were 79 and 91 per cent at 12 months; 56 and 81 per cent at 18 months, and 40 and 65 per cent at 24 months. The over-all and adjusted median survival rate after the treatment was 17 and 23 months, respectively. Of the 14 patients who failed this program, 11 had recurrences at sites other than the liver, with hepatic disease in remission in the majority. Of the 17 patients who died, six died of causes unrelated to the recurrence of disease. Thus, hepatic dearterialization and infusion regional chemotherapy can "effectively" control the hepatic disease and increase over-all survival time from three to six months to 23 months. However, recurrences of extrahepatic carcinoma and other causes are responsible for death and the over-all guarded prognosis.