Surgery of Liver Metastasis in Gynecological Cancer – Indication and Results

Abstract

Background: Liver surgery for patients with liver metastases from gynecological malignancies, an indicator of advanced cancer disease, has remained unclear in the literature. We therefore analyzed the potential survival benefit of patients with surgically resectable compared to unresectable liver metastases. Patients and Methods: 43 patients who underwent surgery for liver metastases from gynecological cancers were included in our retrospective observational analysis. Overall survival was estimated according to the Kaplan-Meier method and compared with the log-rank test. Results: Primary gynecological tumors were breast (n = 27), ovarian (n = 8), and uterine (n = 8) cancers. Solely exploratory laparotomy was performed in 13 patients who served as controls. Whereas the perioperative mortality was 0%, minor complications occurred in 18.7%. The overall survival of all patients undergoing liver resection was significantly higher (p < 0.05) than that of patients with unresectable metastases. Subgroup analyses showed that particularly patients with respectable liver metastases from breast cancer had a significantly higher (50%) 5-year survival compared to patients with only an exploratory laparotomy. Conclusion: In selected patients, liver resection of metastases from gynecological cancers can achieve a survival benefit similar to that of patients with colorectal cancer metastases.

Repeat Hepatectomy for Breast Cancer Liver Metastases

“…In the past years, several articles, including ours, have been published arguing for the benefit of surgery in study populations varying from 2 to 115 patients, with a 5-year survival rate ranging from 27 to 50 %. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] Our current survival rates are similar to these previous publications.…”

“…[9][10][11][12] To date, only a few small retrospective series have been reported regarding the resection of BCLM, with a median survival of 30-70 months and 5-year overall survival rates of 33-50 %. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] At our institution, selected patients with BCLM have routinely undergone surgical resection since 1985, with previously reported promising results. 13 Despite these encouraging results, some patients who underwent hepatectomy with curative intent will experience disease recurrence.…”

Video-Assisted Thoracoscopic Surgery for Recurrent Ovarian Cancer with a Metastatic Mediastinal Mass

“…Nevertheless,althoughdataaboutthefeasibilityandsafety ofextraperitonealmetastasectomyingynecologicmalignancies is limited [9,10], it is believed that surgical resection of hepatic and pulmonary metastases can increase overall survival in selected colorectal cancer patients [11,12]. Furthermore,inselectedpatients,likethedescribedcase,characterizedbyaprotracteddisease-freeintervalwithnogross residualdisease,ithasbeensuggestedthatmetastasectomy conferssurvivalbenefit [13].…”

Surgical Indications, Timing, and Strategy in Non-colorectal Liver Metastases

“…In the most recent and representative case studies series, resection of breast cancer liver metastases shows that the appearance of metastases follows the discovery of the primary tumor of an average of 40 months (23-77), the indication for resection concerns cases with single lesion or a maximum of two lesions, with dimensions within 3 cm in most cases, and that in most cases, major resections were performed (more than 3 liver segments) with values of radical resection (negative margin resection) of more than 80% [118][119][120][121][122][123][124][125]. The average survival values reported by these series range from 32 to 74 months and the 5-year follow-up survival rates are of 34-80%.…”