The amazing regenerating liver: two-step surgery can increase survival after liver metastasis

This study examined the safety and efficacy of a two-step hepatectomy combined with hepatic artery infusion chemotherapy as treatment for liver-spread colorectal cancer.

A common location for metastasis (spread) of colorectal cancer is the liver. Surgical removal of the liver tumor (hepatectomy) can increase survival rates and even cure some patients. However, there are many patients who are unable to undergo this type of surgery, due to the amount of liver that would need to be removed. In these patients, chemotherapy delivered both systemic (to the whole body) and with hepatic artery infusion or HAI (a method that delivers chemotherapy drugs directly to the liver through a tube placed into the hepatic artery, which is the main route of blood supply to the liver and liver tumors), has been shown to increase survival rates. A second treatment option under investigation is the two-step hepatectomy (TSH), in which the tumor is removed from the liver in two surgeries instead of one. This surgery has been found to be effective at increasing survival rates when combined with chemotherapy. The long-term outcomes of this treatment regimen are not yet known. The current study examines the survival and recurrence (return of the cancer) rates associated with TSH combined with HAI-delivered chemotherapy. 

In this study, 35 patients who were not candidates for one surgery to remove liver metastases from colorectal cancer underwent TSH. Each patient received systemic and/or HAI-delivered chemotherapy, which consisted of 5-fluoruracil and leucovorin, combined with oxaliplatin (FOLFOX) or irinotecan (FOLFIRI). Patients were followed up for an average time of 40 months.

The median recurrence-free time for these patients was 11 months. Recurrence was seen in 77% of patients, with 70% of the recurrences being found in the liver. 60% of these patients underwent further surgery, 44% of whom remained disease-free after the 54 months follow-up. The predicted 5-year survival for these patients was 53%, compared to 0% for patients who did not undergo further surgery.

This study concluded that a two-stage hepatectomy combined with systemic and hepatic artery infusion chemotherapy is an effective treatment for patients not eligible for a single surgery to remove liver metastases. 

This study does not discuss the details of the two-stage hepatectomy, such as how long after the first surgery the second occurred. Differences in the timing of the surgeries could affect survival rates.

Consult with your physician the optimal treatment course for your situation.