Resection of unresectable secondary liver tumors--new frontiers in liver surgery

Despite remarkable advances in diagnostic and therapeutic techniques for metastatic liver disease, this disease remains a challenge for patients and surgeons. In this study we describe our experience in the management of 21 patients referred for treatment due to metastatic disease, between 1992 and 1997, in Athens, Greece.

Patients diagnosed with unresectable liver tumors, received a standard treatment, which included neo-adjuvant locoregional immuno-chemotherapy, surgical resection and adjuvant locoregional immuno-chemotherapy. Twenty days after liver resection a standard protocol of combined locoregional immuno-chemotherapy was administered. The protocol included 10 daily courses of transplenic (5-day) and transtumoral (5-day) immunostimulation using proleukine suspended in lipiodol Urografin emulsion. Five days later a standard dose of chemotherapeutical drugs suspended in lipiodol Urografin were given via the catheter of the hepatic artery. The above mode of adjuvant treatment was continued every 2 months for the first postoperative year and every 3 months for the 2nd and 3rd postoperative years, every 4 months for the 4th and 5th postoperative years. At the end of each treatment a blood test, which included the serum values of the tumors markers and an upper abdominal computer tomography was carried out for each patient. The treatment response was evaluated accordingly, and divided into the following categories: complete response, partial response, stable disease and progressive disease.

There was no operative mortality. Sequelae and side effects secondary to treatment were minimal In group A and B of this study a 5-year survival rate of 65% and 20% and an overall response rate of 80% and 68% in the above groups was noted, respectively.

The mode of management offered satisfactory results regarding quality of postoperative life.