Surgical removal of sites of cancer that have spread to the liver (liver metastasis) among patients with colorectal cancer appears to improve survival. These favorable results have even been noted in second surgeries for liver metastasis.
The liver is one of the most common sites in the body to which colorectal cancer spreads. Currently, there are several options for treating liver metastasis, many of which provide therapy directly to the liver. Research continues to compare different treatment strategies for liver metastases. It does appear, however, that surgery provides the best survival benefits.
Not all patients with liver metastases are eligible for surgery. For example, patients may not be eligible if their cancer is growing close to or is attached to a main artery or is found in several sites within the liver. In addition, patients must be physically able to undergo the surgical procedure. Long-term data that includes colorectal cancer patients with liver metastases who undergo surgery are necessary to better understand the effectiveness of this treatment approach.
Researchers from the United States and Austria recently evaluated long-term data from patients diagnosed with colorectal cancer who had liver metastasis.1 Data review included 612 patients who underwent surgery to remove their liver metastases between 1985 and 1994.
- At 10 years there were 102 survivors, 97% of whom were still cancer-free.
- Only one patient died as a result of cancer after 10 years of survival.
- Among patients who were alive at five years following surgery, 34% died from cancer.
- Variables that were associated with poorer outcomes included a cancer-free interval of less than 12 months following therapy, metastasis in two lobes of the liver, cancer that had spread to lymph nodes, more than one site of metastasis, and cancer size larger than 5 centimeters.
There is no standard treatment approach for patients who experience a second cancer recurrence in the liver following surgery for liver metastasis.
Researchers from France recently conducted a study to evaluate data including 40 patients with colorectal cancer who underwent two surgeries for liver metastasis from colorectal cancer.2 The researchers evaluated both short- and long-term results and identified factors that might help determine which subgroups of patients may experience better outcomes with a second surgery.
- The postoperative mortality rate was 2.5%, which was not significantly different between patients who underwent a second surgery and those who only underwent one surgery.
- Overall survival at three years was 55%.
- Overall survival at five years was 31%.
- Cancer-free survival at three year was 49%.
- Cancer-free survival at five years was 27%.
- The presence of cancer outside of the liver was associated with decreased survival.
- If the duration of time between first and second hepatectomies was less than one year, survival was significantly decreased.
The researchers concluded: “A second liver resection because of recurrent liver metastases from colorectal cancer is safe and provides a survival benefit similar to that with single hepatectomy. Our analysis suggests that the benefit of treatment is limited in patients who undergo a second hepatectomy within 1 year of the first operation…. Repeat liver resection because of recurrent colorectal liver metastases can provide survival benefit with a low rate of complications.”
Patients with colorectal cancer who have liver metastases may wish to speak with their physician regarding their individual risks and benefits of surgery. As well, patients with this disease who have already undergone surgery for liver metastases and have experienced a recurrence in the liver appear to benefit from a second surgery. These results are encouraging and may change the outlook for colorectal cancer patients with liver metastasis.
1 Tomlinson J, Jarnagin W, DeMatteo R, et al. Actual 10-Year survival after resection of colorectal liver metastases defines cure. Journal of Clinical Oncology. 2007;25: 4575-4580.
2 Cunha A, Laurent C, Rault a, et al. A second liver resection due to recurrent colorectal liver metastases. Archives of Surgery. 2007;142:1144-1149.