Introduction The current standard of treatment for newly diagnosed ovarian cancer (OC) includes definitive staging or cytoreduction followed by platinum-based chemotherapy. Therefore, studies have explored the implementation of liver resection to achieve complete macroscopic cytoreduction.
Objectives The aim of this study was to describe and evaluate the security of liver resections for OC liver metastases and the benefit in terms of survival as part of cytoreductive surgery.
Methods Data from patients submitted to surgical cytoreduction for OC that included liver resection at Instituto Nacional de Enfermedades Neoplásicas from January 2009 to December 2017 was retrospectively reviewed. The collected information included the patient's age at initial diagnosis, the FIGO staging system, tumor histology and grade, neoadjuvant chemotherapy, associated organ resections, number, dimensions, type and the margin status. Postoperative complications were measured according to Dindo-Clavien score, the length of hospitalization, 30-day mortality, disease-free survival, and overall survival was estimated from the moment surgery. The statistical analysis was made with non-parametric tests; Kaplan-Meyer survival curves were used.
Results 1211 patients were submitted surgical cytoreduction for OC surgery of whom 39 patients had liver resection as part of the surgical treatment of whom 21 had parenchymal metastasis. The mean age of patients was 46 years old, the 87% of patients had stage III/IV OC. 9, 17 and 13 patients had liver resection as part of cytoreductive surgery on primary, secondary and tertiary respectively. 58% of patients had epithelial type ovarian carcinoma, followed by 30% of stromal tumors. 35 patients had single liver metastasis, the mean diameter was 4.38 cm for parenchymal metastasis and 4.55 cm for peritoneal seeding, R0 resection was accomplished in 61% of patients. 33, 3 and 2 patients underwent minor hepatactomy, segmentectomy and major hepatectomy respectively. The margin status was not reported in 76 % of pathology reports. The most frequent associated organ resection was the spleen, omentum and peritoneum. The length of hospital stay was 5 days. 26 and 13 patients had Dindo-Clavien score I and II respectively, the 30-day mortality rate following surgery was 0. The disease free survival was better in patients with peritoneal seeding metastasis, however it was non-significant p:0.127. The overall survival analysis showed no difference p:0.752 between patients who were submitted to parenchymal or peritoneal seeding liver resection.
Conclusions Liver resection for advanced OC is a safe procedure from primary to quaternary cytoreduction and may bring survival benefit. There is a difference in prognosis following surgery between patients with parenchymal or peritoneal seeding liver resection, however further research is needed
Note: This abstract was not presented at the meeting.
Citation Format: Jorge Luna Abanto, Luis Garcia Ruiz, Jheff Laura Martinez, Vladimir Villoslada Terrones. Liver resection as part of cytoreductive surgery for ovarian cancer liver metastases in a national cancer hospital [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4877.
