Resection versus resection combined with adjuvant pre- and post-operative chemotherapy--immunotherapy for metastatic colorectal liver cancer. A new look at an old problem.

Forty patients with metastatic liver disease from colorectal carcinoma are presented in this study. Patients were randomly assigned to two groups: Group A (20 patients) who had liver resection and Group B (20 patients) who had liver resection combined with post-operative locoregional immuno- therapy + chemotherapy. Thus, during the first year following surgery, they have four courses of targeted locoregional transarterial chemotherapy-immunotherapy, two courses during the second year and one course during the third year. Two patients died, one in each group, during the first 30 postoperative days. Survival in Group A (19 surviving patients) ranged from 4 to 25 months, mean 11 months. Eight (8) patients had intrahepatic recurrence of the disease and 11 are still alive and free of disease. Of those with intrahepatic recurrence, three (3) patients died 15, 15 and 17 months following surgery of causes related to the disease. In Group B (19 surviving patients), survival ranged from 3 to 30 months, mean 20 months. At present, all 19 patients are alive and free of disease (p < 0.001). None has had intrahepatic recurrence (p < 0.001). On the basis of present results, liver resection supplemented with postoperative targeted transarterial locoregional immunotherapy-chemotherapy is associated with optimal results. It is highly recommended as the procedure of choice in dealing with patients operated upon for metastatic liver disease due to colorectal carcinoma.