Scientific paper
An attempt to clarify indications for hepatectomy for liver metastases from breast cancer

https://doi.org/10.1016/S0002-9610(02)01204-7Get rights and content

Abstract

Background

Liver metastases (LM) from breast cancer are generally considered as disseminated disease with a poor prognosis. However in selected patients hepatectomy may be an important adjunct to systemic treatment.

Methods

Fifty-four breast cancer patients (mean age 49.2 ± 5.2 years) with LM as the sole site of metastatic disease (except for bone metastases in 3 patients) underwent hepatectomy between 1986 and 2000. The mean number of LM was 4.0 ± 8. All patients presented either a stable disease or an objective response to chemotherapy. The last 25 patients also underwent hepatic artery catheter installation in order to receive postoperative hepatic artery infusion chemotherapy (HAIC).

Results

The postoperative morbidity was 12.9%. There was no postoperative mortality. R0 and R1-R2 resections were obtained in, respectively, 81.5% and 18.5% of patients. After a median follow-up of 32 months the median survival was 34 ± 9 months, with 3- and 5-year overall survival rates of 50% and 34%, and 3- and 5-year disease-free survival rates of 42% and 22%, respectively. The number of LM, the presence of hilar lymph nodes (33%), and the completeness of resection had no significant prognostic impact. The only factor influencing survival in both the univariate and multivariate analysis was the hormone receptor status (P = 0.03): the relative risk of death was increased by 3.5-fold when negative. In the HAIC group, the liver recurrence rate decreased from 60.5% to 31.2% without any impact on global survival.

Conclusions

Hepatectomy is beneficial for selected patients with isolated LM. Indications should be based more on technical (low operative risk, probable R0 resection) than on oncologic criteria. The decision is simple for young patients but more difficult for older patients in whom a negative hormone receptor status appears to be a contraindication.

Section snippets

Patients and methods

Between January 1986 and January 2001, 54 selected women underwent hepatectomy for LM from breast cancer and were prospectively recorded in a specific database. Selection criteria before proposing hepatectomy (in a multidisciplinary staff meeting) were theoretically: (1) absence of extrahepatic metastases; (2) a good performance status (WHO 0 or 1); (3) absence of complex and risky liver resections (invasion of the hepatic hilum, the inferior vena cava or the hepatic veins) in order to minimize

Surgery

Intraoperative liver ultrasonography discovered additional LM in 20 patients (47.6%), leading to modification of the initially planned liver resection in exactly half of the patients. The type of resection was a right hepatectomy (segments V to VIII according to Couinaud’s classification) in 20 patients, an extended right hepatectomy (segments IV to VIII) in 7, a left hepatectomy (segments II to IV) in 3, an extended left hepatectomy (segments I to V and VIII) in 2, a segmentectomy in 6, a

Comments

Breast cancer associated with visceral metastases is usually considered to be a systemic disease with poor prognosis. The standard approach of patients with newly diagnosed metastatic breast cancer is to determine the extent of metastatic disease and whether there are sites of disease that require urgent treatment. After this initial evaluation, the key question for the clinician is whether the patient is likely to benefit from hormonal therapy [14]. Whenever possible, hormonal therapy should

References (30)

  • J.W. Pickren et al.

    Liver metastasisanalysis of autopsy data

  • Y.T. Lee

    Breast carcinomapattern of recurrence and metastasis after mastectomy

    Am J Clin Oncol

    (1984)
  • Y. Fong et al.

    Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer. Analysis of 1001 consecutive cases

    Ann Surg

    (1999)
  • M.D. McCarter et al.

    Role of surgical cytoreduction in multidisciplinary treatments for cancer

    Ann Surg Oncol

    (2001)
  • R. Raab et al.

    Liver metastases in breast carcinoma. Results of partial liver resection

    Chirurg

    (1996)

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