Implantation Techniques of Arterial and Venous Ports

Inefficiency of metastasis from colorectal carcinomas

“…At first glance, it might appear that high-dose regional therapy directed at the liver, as described by Aigner et al [17) and others, could only have a curative potential in metachronously seeded metastases confined to the liver. In the case of synchronous seeding, regional therapy to the liver could only be palliative because micrometastases «2 mm diameter) are expected to present fewer drug-delivery problems than overt lesions; these may well respond to 'spillage' from regional therapy or separate systemic therapy.…”

“…Both depend on metastatic inefficiency and involve metachronous and/or synchronous seeding of the liver, lungs, and other sites. It is of considerable importance to discriminate between metachronous and synchronous seeding, because the former implies that hematogenous metastasis could be confined to the liver for a time, and thus be potentially treatable by local, liver-directed therapy [17]. In contrast, the concept of synchronous seeding implies that subclinical, undetected small lesions are present in the lungs and other organs at the same time as the detected liver metastases, and that liver-directed therapy alone would therefore be ineffective.…”