Results of Hepatic Resection for Sarcoma Metastatic to Liver

Abstract

ObjectiveTo evaluate the outcome of patients with liver metastases from sarcoma who underwent hepatic resection at a single institution and were followed up prospectively. Summary Background DataThe value of hepatic resection for metastatic sarcoma is unknown. MethodsThere were 331 patients with liver metastases from sarcoma who were admitted to Memorial Hospital from 1982 to 2000, and 56 of them underwent resection of all gross hepatic disease. Patient, tumor, and treatment variables were analyzed to assess outcome. ResultsOf the 56 patients who underwent complete resection, 34 (61%) had gastrointestinal stromal tumors or gastrointestinal leiomyosarcomas. Half of the patients required an hepatic lobectomy or extended lobectomy. There were no perioperative deaths in the completely resected group, although 3 of the 75 patients who underwent exploration (4%) died. The postoperative 1-, 3-, and 5-year actuarial survival rates were 88%, 50%, and 30%, respectively, with a median of 39 months. In contrast, the 5-year survival rate of patients who did not undergo complete resection was 4%. On multivariate analysis, a time interval from the primary tumor to the development of liver metastasis greater than 2 years was a significant predictor of survival after hepatectomy. ConclusionsComplete resection of liver metastases from sarcoma in selected patients is associated with prolonged survival. Hepatectomy should be considered when complete gross resection is possible, especially when the time to the development of liver metastasis exceeds 2 years.Patients with liver metastases from soft tissue sarcoma have been treated primarily with chemotherapy or supportive care. The value of hepatic resection for liver metastases from sarcoma is unknown; the few published reports are mostly anecdotal.

Clinical manifestations and prognostic factors in patients with gastrointestinal stromal tumors

“…Locally recurrent tumors were usually not amenable to complete resection because of peritoneal implantation [19] , nor has chemotherapy been very effective [20] . Solitary liver metastasis could be surgically resected [21] , but multiple liver metastases are difficult to manage. Transcatheter arterial embolization has been used, but the partial response rate was low.…”

Hepatectomia para o tratamento de metástases colorretais e não-colorretais: análise comparativa em 30 casos operados

“…E seus resultados em longo prazo têm sido surpreendentes quando realizadas em casos adequadamente selecionados. Metástases de tumores do trato genito-urinário, de mama e de sarcomas parecem apresentar resultados comparáveis aos de origem CR (9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Em nossas meio, pequenas séries de casos de ressecção hepática de metástases de sarcomas, mama e também de outros primários tem sido também descritas (19)(20)(21).…”

Management of liver metastases from gastrointestinal stromal tumors: where do we stand?

“…Surgical resection of LMs from GISTs had historically been considered as a palliative measure (11). In the past, patients with LM from sarcomas treated with surgery alone had median survivals of 37-39 months (10,12). Recent studies however, have highlighted the beneficial effect of surgical resection in the treatment of metastatic GISTs in combination with TKI administration, reporting 5-year survival rates as high as 91% (14,20).…”

“…Four studies were excluded from our analysis (10)(11)(12)(13). Three of them reported results on additional malignancies and did not fulfill our inclusion criteria (10,11,13).…”

“…Three of them reported results on additional malignancies and did not fulfill our inclusion criteria (10,11,13). The forth study in addition to including LM from various sarcomas also encompassed radiofrequency ablation as a therapeutic strategy (12).…”