The role of liver-directed surgery in patients with hepatic metastasis from primary breast cancer: A multi-institutional analysis

Abstract

Introduction: Data on surgical management of breast liver metastasis are limited. We sought to determine the safety and long-term outcome of patients undergoing hepatic resection of breast cancer liver metastases (BCLM). Methods: Using a multi-institutional, international database,111 patients were identified who underwent curativeintent surgery for BCLM between 1986e2012. Clinicopathologic, operative and outcome data were collected and analyzed. Results: Median patient age was 56 years (IQR: 46e66) and most patients (93.7%) were white. Median size of the primary breast cancer was 2.5 cm (IQR: 2.0e3.0); 43 (55.1%) patients had primary tumor nodal metastasis. Among patients with metachronous disease (n = 54, 48.6%), the median time from diagnosis of the breast cancer to the resection of liver metastasis was 55.3 months (IQR: 31.2e93.5). The mean size of the largest liver lesion was 3.0 cm (2.0e4.5); most patients (54.1%) had a solitary metastasis. At surgery, almost twoethirds of patients (62.2%) underwent a minor hepatectomy; an R0 resection was achieved in most patients (91.3%). Postoperative morbidity and mortality were 23.9% and 0%, respectively. Median, 3-and 5-year disease-free survival was 24.0 months, 40.4% and 23.7%, respectively. Median, 3-and 5-year overall-survival was 53.4 months, 75.2% and 45.7%, respectively (Figure). On multivariable analysis, surgical margin status was an independent predictor of worse overall survival (HR 4.39,;P = 0.001). Conclusions: In selected patients, resection of breast cancer liver metastases can be done safely and is associated with low morbidity and zero mortality. Although recurrence occurs in about one-half of patients by 5-years following surgery, a subset of patients may derive a survival benefit, especially from a margin negative resection.

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

“…The difference in surgical results between reported patient series is also not negligible [8,24]. From a multi-institutional, international database analysis, a median survival time of 53.4 months and 3-year survival rate of 75.2% were reported for 131 patients who underwent hepatectomy of liver metastasis from breast cancer during 34-year period [25]. These outcome data are similar to ours.…”

Clinical practice guidelines for the management of liver metastases from extrahepatic primary cancers 2021

“…Four cohorts and six case series that reported complications of the hepatectomy were identified. The complication rates were reported to be 10%‐23% 165–174 …”

“…The complication rates were reported to be 10%-23%. [165][166][167][168][169][170][171][172][173][174] These results indicate that liver metastases from breast cancer are rarely isolated to the liver, and hepatectomy cannot be recommended when compared to chemotherapy alone, except possibly in highly selected patients with confirmed isolated liver metastases. The invasiveness of the hepatectomy and the possibility of curative resection should be considered when selecting hepatectomy.…”

Hepatectomy, RFA, and Other Liver Directed Therapies for Treatment of Breast Cancer Liver Metastasis: A Systematic Review

“…Twenty-one studies provided detail of surgical resection ( 8 , 9 , 13 , 16 – 32 )—there were a total of 437 major hepatectomies (47.1%). Approximately 597 (79.6%) obtained R0 resection ( 8 , 9 , 16 – 21 , 23 , 25 , 27 – 30 , 32 ). Mortality rates were available for 19 studies ( 8 , 9 , 13 – 21 , 23 , 25 , 27 – 32 ) which was consistently low across with a median of 0% (0–5.5%).…”

“…Some reported “perioperative” mortality, while others reported “in-hospital” mortality, or “30-day” mortality. Tumor histology was provided in 12 studies, totaling 424 patients with ductal carcinoma, 77 with lobular carcinoma, and 10 mixed or other histology ( 8 , 15 – 17 , 19 – 25 , 28 , 30 , 32 ). No studies stratified outcomes based on primary tumor histology.…”