Surgical resection versus perfusion in the treatment of metastatic and primary liver tumors

The involvement of the liver by malignancy, whether it be primary or metastatic, carries a grave prognosis. At this time, chemotherapy is solely palliative, and no survival advantage has been established. Resection of metastatic or primary carcinoma of the liver in a select number of patients may provide a survival advantage and an occasional cure. However, studies are difficult to control, and claims of survival benefits have been based on historical data of untreated disease prior to 1978. Currently, clinical trials are underway combining modes of therapy in the hope of increasing patient survival. Reduction of operative mortality to below five percent for liver resection is attributable to a major advance in operative technique. Other advances are improved diagnostic techniques for detection of liver metastases and selection of patients for resection. Finally, newer strategies for chemotherapy made practicable continuous infusion by implantable or external pumps, redoubling response rates to fluorodeoxyuridine (FUDR) in regional and 5-fluorouracil (5-FU) in systemic chemotherapy. A review of the current literature is presented along with data accumulated over the three-year experience of the Moffitt Cancer Center, Tampa, Florida. The case material from Moffitt Cancer Center is included to illustrate progress and limitations of combined surgical, regional, and systemic chemotherapy for primary and metastatic liver cancers.