Outcomes of 1,639 hepatectomies for non‐colorectal non‐neuroendocrine liver metastases: a multicenter analysis

Abstract

Background Whether non‐colorectal non‐neuroendocrine liver metastasis (NCNNLM) should be treated surgically remains unclear. Methods Data regarding 1,639 hepatectomies performed between 2001 and 2010 for 1,539 patients with NCNNLM were collected from 124 institutions. Patient characteristics, types of primary tumor, characteristics of liver metastases, and post‐hepatectomy outcomes were analyzed. Results The five most frequent primary tumors were gastric carcinoma (540 patients [35%]), gastrointestinal stromal tumor (204 patients [13%]), biliary carcinoma (150 patients [10%]), ovarian cancer (107 patients [7%]), and pancreatic carcinoma (77 patients [5%]). R0/1 hepatectomy was achieved in 90% of patients, with 1.5% in‐hospital mortality rate. Overall and disease‐free survival rates of 1,465 patients included in survival analysis were 41% and 21%, respectively, at 5 years, and 28% and 15%, respectively, at 10 years. Five‐year survival associated with the five frequent primary tumors were 32%, 72%, 17%, 52%, and 31%, respectively, and factors predictive of a poor outcome differed by the primary tumor type. Conclusions Our data indicated that hepatectomy is safe for NCNNLM and that patient prognoses vary depending on the type of primary tumors. Indications for hepatectomy should be determined with reference to survival rates and risk factors specific to each of the various types of primary tumor.

Short- and long-term outcomes of surgery for colorectal and non-colorectal liver metastasis: a report from a single center in the Baltic country

“…The present study confirmed similar safety of liver resection for CRLM and non-CRLM. Our findings are consistent with some previous reports suggesting satisfactory short-term outcomes in patients with non-CRLM since the modern and standardized operation techniques are adopted [ 8 – 11 ]. Liver surgery changed in the past 20–30 years after resections became refined, and with an accumulation of evidence, liver parenchyma-sparing techniques, such as atypical resections for metastases, became dominant to preserve liver volume and function [ 12 ].…”

<p>Prognostic Factors After Hepatectomy for Gastric Adenocarcinoma Liver Metastases: Desmoplastic Growth Pattern as the Key to Improved Overall Survival</p>

“…A recent meta-analysis of Montagnani et al 18 found that metachronous appearance was associated with longer OS consistent with previous studies. 36,37 On contrary, a systematic review of Markar et al, 16 as well as several other studies, 7,11,13,17 failed to prove that metachronous resection was a determinant of prognosis. All these studies showed that solitary metastases and minor resections were predictors of better survival rates.…”

Is there a role for treatment-oriented surgery in liver metastases from gastric cancer?

“…On the other hand, the literature reported better survival for patients with hepatic lesions < 5 cm[ 8 , 14 , 51 , 52 ], but in this case there was also no consensus. In fact, other authors[ 49 , 53 , 54 ] considered a maximum diameter of 3 cm as closely related to an increase in survival. In this regard, it is interesting to note how the presence of ≥ 3 metastases, lesion diameter of > 5 cm, and advanced stage of serous infiltration of the primary tumor are related to poor prognosis[ 14 , 55 ].…”

“…Other features of metastases, such as carcinoembryonic antigen/carbohydrate antigen 19.9 (CEA/CA19-9) levels, venous or lymphatic infiltration, histological metastases differentiation, and surgical type of liver resection, do not seem to be prognostic factors to be considered[ 27 , 39 , 46 , 53 ].…”