Resection of liver

Following resection of liver metastases, infusion of chemotherapy through the portal vein provides an additional adjuvant treatment approach. Historically 5-FU and floxuri-dine have been the agents used most commonly for hepatic portal vein infusion owing to their high metabolism in the liver. Although some studies demonstrate a decrease in recurrence rates, the value of portal vein infusion of chemotherapy for colon cancer remains to be determined.25 Table 88-4 summarizes adjuvant treatment recommendations for colon cancer. 

To date, resection of liver metastases of colorectal or neuroendocrine tumours is the only treatment option which may result in definitive removal of the cancerous disease. Resection is indicated in those cases in which the primary tumour can be removed completely and when no further metastases are detectable. Repeated resection is also possible. Extrahepatic metastases or involvement of neighbouring organs are generally no longer regarded as contraindications. (3ll, 316, 317)... 

Ishida et al. (12) reported that the levels of MMP-9 in portal blood of patients with colorectal cancer and liver metastases correlated with characteristics of the primary tumor. By setting the cutoff ratio of portal to peripheral blood MMP-9 levels at 1.6 in patients subjected to curative resection, elevated ratios predicted subsequent emergence of liver metastases with 78% sensitivity, 81% specificity, and 81% accuracy. The authors concluded that synchronous determination of plasma MMP-9 levels of portal and peripheral blood at curative resection of liver metastases may be useful for selecting colorectal cancer patients at high risk of hepatic recurrence. 

Weitz, J., Koch, M., Kienle, P., Schrodel, A., Willeke, F., Benner, A., et al., Detection of hematogenic tumor cell dissemination in patients undergoing resection of liver metastases of colorectal cancer. Arm. Surg. 232, 66-72 (2000). 

Elias D, Cavalcanti de Albuquerque A, Eggenspieler P et al (1998) Resection of liver metastases from a noncolorectal primary indications and results based on 147 monocentric patients. J Am Coll Surg 187 487-493... 

Sakamoto Y, Ohyama S, Yamamoto J et al (2003) Surgical resection of liver metastases of gastric cancer an analysis of a 17-year experience with 22 patients. Surgery 133 507-511... 

Miyazaki M, Itho H, Nakagawa K et al (1997) Hepatic resection of liver metastases from gastric carcinoma. Am J Gastroenterol 92 490-493... 

Curative resection of liver metastases is mainly performed in patients presenting with colorectal primary cancer. Liver metastases are found in 40%-70% of patients with a colorectal cancer. In about one third of cases, the liver is shown to be the only site of cancer spread, even at autopsy. There is no spontaneous long-term survival in untreated patients, whose median survival time range from 6 to 18 months. Furthermore, liver involvement is the most important factor associated with decreased patient survival. However, at time of diagnosis, the majority of patients present unresectable tumors, and resection can be performed in <20% of all patients with colorectal liver metastases. The main limitation for resectahility is the impossibility to be curative while leaving a sufficient residual amount of functional liver parenchyma. Consequently, preoperative PVE may dramatically improve the possibilities for a curative (RO) resection of liver metastases by increasing the volume and the function of the future remnant liver. 

First results of the use of water jets for medical applications have been pubhshed in 1982 - a plain waterjet scalpel for the resection of liver tissue has been appUed [62]. The use of the plain waterjet offers an important advantage over conventional surgery and ultrasound or laser cutting athermic and selective cutting - the plain waterjet under low pressure (below 100 bar) cuts the tissue but the blood vessels are not injured, because they are slightly more resistant There are several other possibilities to exploit the potential of the plain waterjet in medicine, such as... 

Adson MA (1987) Resection of liver metastases - when is it worthwhile World ] Surg 11 511-520... 

Cady B, Stone MD (1991) The role of surgical resection of liver metastases in colorectal carcinoma. Semin Oncol... 

The opinion that resection of liver metastases is not indicated, which unfortunately is still part of many medical and oncological approaches, should be seen as dated in the light of the results from both the established and new strategies, which using multimodal treatment offer long-term survival or cure even in advanced cases. 

Hunt TM, Carty N, Johnson CD (1990) Resection of liver metastases from a colorectal carcinoma does not benefit the patient. Ann R Coll Surg Engl 72 199-205 Imamura H, Sano K, Harihara Y, et al (2003) Complete remission of disease for 5 years following initial and repeat resection of the liver for the removal of 22 metastases of colorectal origin. J Hepatobiliary Pancreat Surg 10 321-324... 

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