Liver metastases with massive portal venous tumor thrombi from colorectal cancer: can be treated by surgical resection?

BACKGROUND/AIMS: The surgical treatments for liver metastases from colorectal cancer with massive portal venous tumor thrombi were evaluated.

METHODOLOGY

Five patients, among the 142 patients who underwent hepatic resection for liver metastases from colorectal cancer from 1989 to 1998, were included in this study. The tumor thrombi in the main portal vein were removed by the following procedures; (1) the circumferential incision of the first branch of the portal vein and removal of the exposed tumor thrombi with ring forceps and suction, (2) temporary clamping of the distal end, (3) dilatation of the round ligament and the venous cannula was inserted into the umbilical portion, (4) washing out of the residual tumor thrombi, (5) declamping of the distal end and closing suture of the cut end of the portal branch.

RESULTS

All patients had metachronous metastases and underwent resections of the primary tumor within 2 years. The surgical procedures performed were as follows: two cases that underwent right hepatectomies with portal venous tumor thrombectomies, one right trisectionectomy with portal venous tumor thrombectomy, one right hepatectomy plus limited resection of the contralateral lobe, and one left lateral sectionectomy with limited resection of the right lobe. All patients had no major postoperative complications and returned to their social lives within 1 month after operation. The intra-arterial catheter devices were implanted in four patients in order to receive adjuvant chemotherapy. One patient survived the 36-month period after liver resection, although 4 patients died of liver recurrence within 12 months. The mean survival time was 14.4 months and the overall 1-year survival rate was 20.0 percent.

CONCLUSIONS

Surgical resection for this disease may bring longer survival rates for some patients, but not be an effective therapeutic option in our series. We should create other adjuvant therapies to improve these survival rates.