This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Elias, D. Articles by Ducreux, M. Search for Related Content PubMed Articles by Elias, D. Articles by Ducreux, M.

Outcome of Posthepatectomy-Missing Colorectal Liver Metastases after Complete Response to Chemotherapy: Impact of Adjuvant Intra-arterial Hepatic Oxaliplatin

¹ Department of Surgical Oncology, Institut Gustave Roussy, 39, Rue Camille Desmoulins, 94805 Villejuif, Cédex, France
² Department of Medical Oncology, Institut Gustave Roussy, 39, Rue Camille Desmoulins, 94805 Villejuif, Cédex, France
³ Department of Pathology, Institut Gustave Roussy, 39, Rue Camille Desmoulins, 94805 Villejuif, Cédex, France
⁴ Department of Radiology, Institut Gustave Roussy, 39, Rue Camille Desmoulins, 94805 Villejuif, Cédex, France

Correspondence: Address correspondence and reprint requests to: Dominique Elias, MD, PhD; E-mail: elias{at}igr.fr

Background: Dramatic responses to chemotherapy are occurring more and more frequently in patients with multiple colorectal liver metastases (LMs), leading to resection. In a few patients, some LMs vanish on imaging studies, remain undetected during hepatectomy, and are left in place, which defines the "missing LMs." The aim of our study was to assess the long-term outcome of such "missing LMs."

Patients: Between January 1999 and June 2004, among 228 patients treated for colorectal LMs, missing LMs were observed in 16 patients. All the patients were operated within 4 weeks of imaging. Hepatic arterial infusion (HAI) with oxaliplatin was administrated in 12 patients (75%): seven before hepatectomy and five after.

Results: Overall, 69 missing LMs were diagnosed and left in place. Among the persistent LMs resected, a complete pathological response was significantly more often observed in the group with preoperative HAI (6 of 7), than in the group without (2 of 9, P < .02). With a mean follow-up of 51 months (24–90), missing LMs did not reappear in 10 patients (62%). Adjuvant HAI was significantly correlated with the definitive eradication of missing LMs (P < .01), as it was not a complete pathological response. The overall 3-year survival rate of these highly selected 16 patients was 94%.

Conclusion: Colorectal LMs under chemotherapy that vanish on high-quality imaging studies, remain undetected during hepatectomy, and are left in place, are definitively cured in 62% of cases. This excellent result seems to be due to the administration of adjuvant hepatic arterial infusion of chemotherapy and should stimulate new investigations.

Key Words: Missing metastases • Colorectal cancer • Chemotherapy • Complete response • Liver metastases • Intra-arterial chemotherapy • Hepatectomy • Oxaliplatin

This article has been cited by other articles:

				D. G. Power and G. D. Leonard Hepatic Arterial Infusion: A Treatment at the "End of an Era"? J. Clin. Oncol., May 20, 2008; 26(15): 2597 - 2598. [Full Text] [PDF]