Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival

Annals of Surgery
Rene AdamH Bismuth

Abstract

To evaluate the long-term survival of patients resected for primarily unresectable colorectal liver metastases (CRLM) downstaged by systemic chemotherapy and to use prognostic factors of outcome for a model predictive of survival on a preoperative setting. Surgery of primarily unresectable CRLM after downstaging chemotherapy is still questioned, and prognostic factors of outcome are lacking. From a consecutive series of 1439 patients with CRLM managed in a single institution during an 11-year period (1988-1999), 1104 (77%) initially unresectable (NR) patients were treated by chemotherapy and 335 (23%) resectable were treated by primary liver resection. Chemotherapy mainly consisted of 5-fluorouracil and leucovorin combined to oxaliplatin (70%), irinotecan (7%), or both (4%) given as chronomodulated infusion (87%). NR patients were routinely reassessed every 4 courses. Surgery was reconsidered every time a documented response to chemotherapy was observed. Among 1104 NR patients, 138 "good responders" (12.5%) underwent secondary hepatic resection after an average of 10 courses of chemotherapy. At time of diagnosis, mean number of metastases was 4.4 (1-14) and mean maximum size was 5.2 cm (1-25). Extrahepatic tumor was present in ...Continue Reading

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Citations

Jun 20, 2006·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Graeme PostonJean-Nicolas Vauthey
May 14, 2008·HPB Surgery : a World Journal of Hepatic, Pancreatic and Biliary Surgery·Kurinchi S GurusamyBrian R Davidson
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