Background: More than one third of breast cancer patients including those that are diagnosed in early stages will develop distant metastasis. Patterns of distant metastasis and the associated risks according to the molecular subtypes are not completely revealed particularly in populations of patients with delayed diagnosis and advanced stages. Methods: Breast cancer patients (n = 1304) admitted to our institute (2014-2017) were evaluated to identify the metastatic patterns and the associated risks. Metastatic breast cancers at diagnosis were found in 245 patients (18.7%), and 1059 patients were then grouped into non-metastatic and metastatic groups after a median follow-up of 3.8 years. Results: Infiltration of the tumor to the skin and chest wall prevailed as the most powerful predictor for distant metastasis (OR 2.115, 95% CI 1.544-2.898) particularly in the luminal Alike subtype (OR 2.685, 95% CI 1.649-4.371). Nodal involvement was also significantly associated with the risk of distant metastasis (OR 1.855, 95% CI 1.319-2.611), and the risk was higher in the Luminal Alike subtype (OR 2.572, 95% CI 1.547-4.278). Luminal Alike subtype had a significant higher risk of bone metastasis (OR 1.601, 95% CI 1.106-2.358). In respect to treatment, a combination of anthracyclines and taxanes-based chemotherapy was significantly associated with lower distant organ spread in comparison with anthracycline-based chemotherapy (OR 0.510, 95% CI 0.355-0.766) and the effect was stronger in Luminal Alike subtype (OR 0.417, 95% CI 0.226-0.769). Classification into Luminal and non-Luminal subtypes revealed significant higher risks of bone metastasis in the Luminal subtype (OR 1.793, 95% CI 1.209-2.660) and pulmonary metastasis in non-Luminal breast cancer (OR 1.445, 95% CI 1.003-2.083).

Introduction: Following the Louisville and Morioka consensus conferences, laparoscopic left lateral sectionectomy (LLS) is the standard of care for patients requiring resection of segments II and III. This study examines whether there remain any indications for the open operation in current practice. Methods: The study population is a consecutive series of patients undergoing liver resection under the care of an individual hepatobiliary surgeon (AKS) in a regionally accredited liver surgery service. 323 consecutive liver resections undertaken during the period January 2009 to October 2017 provide the study population. There was 1 post-operative death (0.3% mortality). Operations where LLS was the major component of the procedure are included. Patients undergoing left lobe metastasectomy as a component of major right-sided resection are excluded. Case selection for surgery was reviewed prior to operation at a liver surgery multidisciplinary tumour board. Results: There were 13 open LLS and 10 laparoscopic LLS. Contemporaneously stated indications for open LLS were: LLS + non-surface metastasectomy 4, LLS as part of synchronous liver and bowel surgery 2, LLS as part of redo liver resection 2, large 5 cm tumour in II or III abutting IV 2 and patient preference 4. The proportion of LLS undertaken laparoscopically was greater in the second four years of this period (P=0.57; Non-significant; Fisher's exact). Conclusions: Although open LLS as a component of other liver resections, redo surgery or synchronous liver/bowel resection remains a safe procedure these should now be regarded as relative indications with progressively more patients being managed laparoscopically.