Reuters Health Information: Liver resection feasible, effective for less common metastases
Liver resection feasible, effective for less common metastases
Last Updated: 2017-11-22
By Will Boggs MD
NEW YORK (Reuters Health) - Liver resection provides good outcomes for less common metastases not arising from colorectal, neuroendocrine, sarcomatous, or ovarian (NCNSO) tumors, according to a retrospective analysis.
"Resection of liver metastases from colorectal carcinoma is well established and widely accepted," Dr. Myron Schwartz from Icahn School of Medicine at Mount Sinai, New York told Reuters Health by email. "The most interesting finding of our study was that, using similar selection criteria, results similar to those reported in colorectal cancer were achieved in a wide variety of other cancers."
Dr. Schwartz and colleagues used data from 188 patients in three prospective databases to analyze the outcome of liver resection for metastases arising from gastrointestinal, breast, and "other" (genital, pulmonary, melanoma, endocrine, and "various") tumors.
Median follow-up was 16 months for the gastrointestinal group, 35 months for the breast group, and 26 months for the "other" group, according to the October 6 online report in The American Journal of Surgery.
Postoperative complications followed 27.1% of gastrointestinal cases, 30.5% of the breast cases, and 15.7% of other cases. However, overall postoperative mortality was only 1.6% (3 patients).
Tumor recurrence rates were 64.4% in gastrointestinal patients after a median 6.9 months, 71.2% in breast patients after a median 14.4 months, and 60% of other patients after a median 6.5 months.
Median overall survival was 24.3 months for the gastrointestinal group, 97.6 months for the breast group, and 65.7 months for the "others" group, with corresponding 5-year survival rates of 33%, 61%, and 52%, respectively.
Greater tumor diameter (35 mm or larger) predicted higher recurrence and poorer survival for gastrointestinal tumors; age >60 predicted lower survival for breast tumors and higher recurrence for other tumors.
"While initial management of metastatic cancer is generally with systemic therapy, in patients with oligometastatic disease and a long interval since resection of the primary tumor, consideration should be given to resection of metastases, even in cancer types where this has not been incorporated into guidelines," Dr. Schwartz concluded.
Dr. Nicolae Bacalbasa from Carol Davila University of Medicine and Pharmacy, Bucharest, Romania, who has studied liver resection for metastases from breast, ovarian, and cervical cancers, told Reuters Health by email, "Previous papers concluded that R0 resection, rather than size of the metastasis, impacts on survival. According to the current paper, size, at least in case of GI metastases, has a significant impact on survival. Further prospective study is necessary to establish if size of the metastasis is a specific prognostic factor for GI metastasis or this can be extended to metastases from other primaries."
"Further prognostic criteria are required (e.g., size, presence of receptors, disease free interval, response to chemo, age, gender, etc.) to determine who benefits the most from liver resection," he said.
"The key is patient selection," Dr. Bacalbasa said. "The more we know about who benefits, the more we know who to resect, and guidelines can be developed."
Am J Surg 2017.