Copyright ©The Author(s) 2005. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 7, 2005; 11(25): 3817-3822
Published online Jul 7, 2005. doi: 10.3748/wjg.v11.i25.3817
Current preventive treatment for recurrence after curative hepatectomy for liver metastases of colorectal carcinoma: A literature review of randomized control trials
Peng Wang, Zhen Chen, Wen-Xia Huang, Lu-Ming Liu
Peng Wang, Zhen Chen, Wen-Xia Huang, Lu-Ming Liu, Department of Oncology, Shanghai Medical College of Fudan University and Department of Liver Neoplasms, Cancer Hospital of Fudan University, Shanghai 200032, China
Author contributions: All authors contributed equally to the work.
Correspondence to: Peng Wang, Department of Liver Neoplasms, Cancer Hospital of Fudan University, 270 Dong An Road, Shanghai 200032, China.
Telephone: +86-21-64175590-1304 Fax: +86-21-64434191
Received: September 18, 2004
Revised: December 15, 2004
Accepted: December 21, 2004
Published online: July 7, 2005

To review the preventive approaches for recurrence after curative resection of hepatic metastases from colorectal carcinoma, we have summarized all available publications reporting randomized control trials (RCTs) covered in PubMed. The treatment approaches presented above include adjuvant intrahepatic arterial infusion chemotherapy, systemic chemotherapy, neoadjuvant chemotherapy, and immunotherapy. Although no standard treatment has been established, several approaches present promising results, which are both effective and tolerable in post-hepatectomy patients. Intrahepatic arterial infusion chemotherapy should be regarded as effective and tolerable and it increases overall survival (OS) and disease-free survival (DFS) of patients, while 5-fluorouracil-based systemic chemotherapy has not shown any significant survival benefit. Fortunately chemotherapy combined with hepatic arterial infusion and intravenous infusion has shown OS and DFS benefit in many researches. Few neoadjuvant RCT studies have been conducted to evaluate its effect on prolonging survivals although many retrospective studies and case reports are published in which unresectable colorectal liver metastases are downstaged and made resectable with neoadjuvant chemotherapy. Liver resection supplemented with immunotherapy is associated with optimal results; however, it is also questioned by others. In conclusion, several adjuvant approaches have been studied for their efficacy on recurrence after hepatectomy for liver metastases from colorectal cancer (CRC), but multi-centric RCT is still needed for further evaluation on their efficacy and systemic or local toxicities. In addition, new adjuvant treatment should be investigated to provide more effective and tolerable methods for the patients with resectable hepatic metastases from CRC.

Keywords: Preventive treatment, Recurrence, Hepatectomy, Metastatic colorectal cancer, Randomized control trials