Multimodal treatment options for bilobar colorectal liver metastases

Abstract

Purpose We evaluated individualized multimodal oncological strategies in patients with bilobular colorectal liver metastases (biCRC-LM) as well as their effect on R0 resection rates, disease-free survival (DFS), and overall survival (OS). Methods Between January 2001 and December 2008, 64 patients were assigned to straightforward or two-stage liver resection ± preoperative 5-fluorouracil (5FU)-based chemotherapy (CTx). Postoperative strategy after R0-resection was either "wait and see" or "adjuvant" therapy (3 cycles of CTx or anti-carcinoembryonic antigen (CEA)-radioimmunotherapy with 131I-labetuzumab in a dose of 40-50 mCi/m2). Results Forty-three initially unresectable patients received preoperative CTx for downsizing of their biCRC-LM. Straightforward or two-stage liver resection was intended in 40 and 24 patients, respectively. Histopathologically confirmed R0-liver resection could be achieved in 47 patients. Surgical morbidity and mortality rates were 33% and 1.5%, respectively. Postoperatively, 26 patients received anti-cancer therapy (5 × CTx, 21 × anti-CEA- radioimmunotherapy). After R0-liver resection, median OS was significantly better compared to R1/R2 resections followed by palliative 5FUCTx (38 versus 19 months, p=0.035). There was no significant difference in DFS (p=0.650) and OS (p=0.435) between straightforward and two-stage liver resection. Compared to "wait and see" strategy, the application ofpostoperative therapy in adjuvant intent was associated with a better OS (p=0.048). Conclusion Extensive liver resection within multimodal treatment concepts is justified in patients with biCRC-LM hen complete resection of all metastases seems to be achievable. © The Author(s) 2010.