CAN RESECTION OF LIVER METASTASIS IMPROVE SURVIVAL AFTER RESECTABILITY CONVERSION CHEMOTHERAPY IN PATIENTS WITH METASTATIC COLO-RECTAL CANCER?

Background: Colon-rectal cancer is the fourth most frequent cancer worldwide, unfortunately 35%-50% develop metastasis, 60%- 80% of them have unresectable liver metastasis, 20% to 34% present with synchronous liver metastasis, while the others are metachronous, only 15%-20% will be candidate for hepatectomy, While chemotherapy can convert around 10% to resectability, R0 surgical resection leads to improvement in median 5-years survival in patients with resected liver metastasis. Aim: To study the efficacy of FOLFOX6 in resectability conversion of unresectable Colo-rectal cancer with liver limited disease. Neo-adjuvant chemotherapy was given to synchronous colorectal liver Mets unfit for upfront resection. Patients and methods: 167 patients presented to the advanced center of liver diseases,Zagazig University hospitals with metastatic Colo-rectal cancer to the liver from June 2012 to September 2015, all patients were assessed clinically, laboratory, pathologicaly. Only 90 patients were eligible, with liver limited disease and adequate organ function and laboratory results, resection the malignant primary site, neo-adjuvant chemotherapy for 1-3months, liver metastasectomy then chemotherapy?radiotherapy completion. Results: our study included 51(56.7%) females and39 (43.3%) males with mean age 47.7 years\' old.68 patient were colon cancer while 22was rectal, 18 patients were converted to resectable . Classical approach for resection was done, 14 patients had anatomical resection while the remaining 4 patients had non-anatomical resection. Postoperative complications occurred in nine patients while recurrence was only in 12patients (two of them died during the follow-up period). CEA level at presentation and before surgery was statistically significant different in the resectable group with p-value 0.001, but this was not the case in the unresectable group with p-value 0.067. The median OS was not reached in the resected group The estimated mean OS for the unresectable group was 15.7?0.96(95% CI 13.8-17.6) compared to 20.1?1.24(95% CI 17.7-22.6) in the resected group that is statistically significant different withp-value 0.015 . Conclusion:chemotherapy can help in resectability conversion of unresectable liver metastasis. Resection for liver Metastasis in cases with Colo-rectal cancer improve survival. - See more at: