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Hepatectomy for Non-Colorectal or Non-Neuroendocrine Liver Metastases
Yasuhito Iwao*, Kazuaki Shimada, Minoru Esaki, Satoshi Nara, Yoji Kishi, Tomoo Kosuge
HBP Surgery, National Cancer Center Hospital, Tokyo, Japan
[Background]Although surgical treatment for liver metastases from colorectal and neuroendocrine has been well established, the role of hepatectomy for liver metastases from other primary tumors, so-called non-colorectal or non-endocrine liver metastases (NCNELM) has not been well evaluated.
[Objective]To examine postoperative outcome and prognostic factors in patients undergoing hepatectomy with NCNELM and establish appropriate patients selection
[Methods]One hundred and sixty one patients who underwent liver resection for NCNELM between January 1990 and December 2009 at a single institution were reviewed retrospectively. Patient demographics, primary disease, tumor characteristics, treatment, and postoperative course were analyzed.
[Results]Patient age ranged from 17-81 years, with a median age of 58. There were 64 women (40%) and 97 men (60%). Liver metastases were synchronous in 43 of 161 (27%).
Hepatectomy was performed for liver metastases from gastric carcinoma (n=59; 36.6%), genitourinary tumors (n=32; 19.9%), and soft tissue primary tumors (n=28; 17.4%). There are four patients from breast cancer and two patients from melanoma.
Overall 5-year and 10-year survival rates were 36% and 27%, respectively. The average follow-up period was 47.4 months (2-260 months). Five-year survival in patients with liver metastases from gastric carcinoma, genitourinary tumors, soft tissue tumors, and others were 25%, 55%, 30%, and 29%, respectively. Genitourinary tumors had a best survival with a significant difference. (p=0.05) Five-year survival for synchronous and metachronous liver metastases was 36% and 34%, respectively. There was no significant difference between both of them. There were 19 patients who underwent repeat hepatectomies in this study. Most of the patient (n=8) were liver metastases from soft tissue tumors of gastrointestinal tract. There is a patient who underwent 4 times hepatectomies for liver metastasis from gastro-intestinal stromal tumor of stomach (alive at 118 months from the primary tumor surgery).
[Conclusions]NCNELM could be resected safely and with accepted survival outcomes in the selected patients. Hepatectomy for genitourinary tumors metastases might be beneficial among the patients with NCNELM. It is important to consider biological behavior of the primary disease and to confirm neither rapid tumor growth nor increase in tumor numbers within a short time interval in appropriate patient selection.
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