The pathogenesis, detection, and surgical treatment of hepatic metastases

Liver function tests in patients with computed tomography demonstrated hepatic metastases

One hundred patients with computed tomographic (CT) evidence of liver metastases (and confirmation by biopsy or progression of disease) had serum levels of alkaline phosphatase, serum glutamic oxaloacetic transaminase, and serum glutamic pyruvic transaminase measured within two weeks of scanning. All three enzymes were within the normal range in 33% of patients. Even with advanced involvement (defined as three or more metastatic lesions over 3 cm in diameter), 20% of patients had normal levels of all three liver enzymes. Although liver function tests (LFTs) (enzyme levels) are inexpensive and simple to perform, they failed to detect a significant number of patients with liver metastases.

Regional chemotherapy of liver metastases from colorectal carcinoma: hepatic artery or portal vein infusion?

Hepatic artery infusion (HAI) chemotherapy has been well developed and is commonly used in the treatment of unresectable hepatic colorectal metastases. However, several important questions are unanswered, such as survival advantage over conventional systemic intravenous chemotherapy, long-term effects on the liver function, and prevention of complications, in particular cholangiosclerosis. Recent investigation into the blood supply of liver tumors challenges the adage that arterial flow is dominant. This review of the merits of regional HAI compared with portal venous infusion (PVI) chemotherapy shows a lack of conclusive data to favor either treatment modality, although a larger experience exists for HAI. Further studies need to be conducted.