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Results of Preoperative Hepatic Arterial Infusion Chemotherapy in Patients Undergoing Liver Resection for Colorectal Liver Metastases

¹ Department of Surgery, LiverUnit, Scientific Institute San Raffaele, Vita-Salute San Raffaele University, Via Olgettina 60,20132 Milan, Italy
² Department of Oncology, Scientific Institute San Raffaele, Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy
³ Department of Radiology, Scientific Institute San Raffaele, Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy

Correspondence: Address correspondence and reprint requests to: Luca Aldrighetti, MD, PhD; E-mail: aldrighetti.luca{at}hsr.it

Background: Although hepatic artery infusion chemotherapy (HAIC) of floxuridine (FUDR) for colorectal liver metastases (CLM) can produce high response rates, data concerning preoperative HAIC are scarce. The aim of this study was to assess the feasibility and results of liver resection after preoperative HAIC with FUDR.

Methods: Between 1995 and 2004, 239 patients with isolated CLM received HAIC in our institution. Fifty of these patients underwent subsequent curative liver resection (HAIC group). Short- and long-term results of the HAIC group were compared with the outcomes of 50 patients who underwent liver resection for CLM without preoperative chemotherapy.

Results: Postoperative morbidity rate were comparable between the two groups. Overall disease-free survival at 1 and 3 years after hepatectomy were 77.5%and57.5%in the HAIC group and 62.9% and 37% in the control group (P = .036). Overall survival from diagnosis of CLM at 1, 3, and5 yearswere97%,59%, and49% in the HAIC group versus 94%, 48%, and35% in the control group (P = .097). When patients were stratified according to clinical-risk scoring (CRS) system, patients with more advanced disease at the time of liver resection (CRS 3) had a median survival of 41 months in the HAIC group (n = 37) and 35 months in the control group (n = 34) (P = .031).

Conclusions: HAIC of FUDR does not negatively affect the outcome of subsequent liver resection. Preoperative HAIC of FUDR may reduce liver recurrence rate and improve long-term survival in patients with more advanced liver disease.

Key Words: Liver surgery • Colorectal liver metastases • Preoperative chemotherapy • Neoadjuvant chemotherapy • Hepatic arterial infusion chemotherapy • FUDR • Liver resection