Surgical treatment of ovarian cancer liver metastasis

Abstract

In addition to hepatocellular carcinoma, metastatic liver cancer (MLC) is another focus of hepatic surgeon. Good outcome of patients with liver metastasis (LM) from colorectal cancer or neuroendocrine tumor have been achieved. Ovarian cancer liver metastasis (OCLM) has its unique oncological characteristics and a variety of metastasis patterns, which brings a challenge to hepatic surgeon. Hepatic surgeons hold different views and techniques from gynecologists, which makes differences in the evaluation and treatment of the disease. We reviewed recent studies and, in combination with our own clinical experience, attempted to introduce the progress of surgical treatment of liver metastases from OC. In our experience, both preoperative imaging and surgical procedures are based on the assurance of R0 resection. R0 cytoreductive surgery (CRS) is the most favorable determinant for the prognosis of OC patients, and R0 liver resection (LR) is a component of R0 CRS. Gynecologists and hepatic surgeons should do their own preoperative and intraoperative evaluation for the extrahepatic and intrahepatic metastasis respectively. During the operation, regardless of the miliary nodules dissemination between the right hemidiaphragm and liver capsule, liver parenchymal infiltration (LPI) or liver parenchymal metastasis (LPM), 1-2 cm resection margin should be emphasized. For patients with liver portal lymph node metastasis (LPLNM), hepatic portal skeletonization should be performed, rather than portal lymph node dissection. The operation should be as radical as possible to ensure the patients to achieve good prognosis.

A Population-Based Study on Liver Metastases in Women With Newly Diagnosed Ovarian Cancer

“…A study of analyzing the safety of laparoscopic secondary cytoreductive surgery in 58 patients with platinum-sensitive recurrent ovarian cancer showed that the median PFS was 28.0 months and the 2 year OS was 90.7% (26). Wang et al found that the OS of ovarian cancer patients with liver metastases who received R0 liver resection and cytoreductive surgery were 50.1 months, however, the OS of patients who received R0 cytoreductive surgery and non-R0 liver resection was 20.0 months (27). Some selected patients with cytoreductive surgery and liver resection had better outcome.…”

Percutaneous microwave ablation versus surgical resection for ovarian cancer liver metastasis

“…Hepatic surgeons are responsible for assisting gynecologists in improving the prognosis of patients. Wang et al reported that the OS time of patients with OCLM who received R0 laparoscopic liver resection (LR) was 50.1 months, which was significantly higher than that of patients who received non-R0 LR (20.0 months) when the primary OC received cytoreductive surgery (CRS) [15].…”

Advances in surgical treatment of ovarian cancer liver metastasis

“…Peritoneal dissemination (PD), as the most common pattern, usually leads to tumor implantation in the liver capsule, hepatorenal recess and hepatic diaphragm (right diaphragms to hepatic capsule), which might be caused by the continuous clockwise movement of OC cancer cells with intestinal peristalsis and ascites. 15,16 The incidence of PD is 40-90% and does not invade liver parenchyma, indicating OC stage III. 4,16 The incidence of diaphragmatic metastasis in advanced or recurrent OC is also very high, about 20-40%, even as high as 91%.…”