Analysis on curative effect and prognostic factors of hepatectomy for hepatic metastasis in patients with ovarian cancer

Abstract

Objective To investigate the impact and prognostic factors of partial hepatectomy on hepatic metastasis in patients with ovarian cancer. Methods Thirty-eight patients with hepatic metastasis of ovarian cancer in the First and the Third Affiliated Hospital of Sun Yat-sen University from January 2001 to December 2011 underwent hepatectomy. Among them, 21 cases with synchronous liver metastases underwent ovary cytoreductive surgery(CRS) and partial liver resection simultaneously(CRS plus liver resection group). The other 17 cases with metachronous liver metastasis underwent partial liver resection in 3 to 12 months later (CRS plus later liver resection group). Surgical resection included 24 cases of irregular hepatectomy, 7 cases of left lateral lobectomy, 5 cases of left lobectomy, 2 cases of right lobectomy. Blood loss during operation, intraoperative blood transfusion, postoperative complications and mortality were observed. The amount of intraoperative bleeding and blood transfusion were compared between the CRS plus liver resection group and CRS plus later liver resection group. All these patients were followed up and the survival rate was observed. Clinical pathological data of ovarian cancer with liver matastasis such as histological type, grade of differentiation, onset time, the number of foci, diameter and capsule of metastasis tumor were collected and analyzed to define prognostic factors. The amount of intraoperative bleeding and blood transfusion were compared between two groups by statistical method of t test. Life-Table was used to calculate the cumulative survival rate and Long-rank test to compared the difference of survival rate. Results The operations were successfully performed in 38 patients. The average intraoperative blood loss was (530±55)ml and intraoperative blood transfusion was (457±33)ml in CRS plus liver resection group, while the average blood loss and blood transfusion in CRS plus later liver resection group was (340±35)ml and (227±22)ml respectively. There was significant difference between two groups in the amount of blood loss and blood transfusion (all in P<0.05). There was no operation death case. The major postoperative complications were transient hypoalbuminemia and moderate to massive ascites. Patients recovered by supportive and symptomatic treatment. Thirty-eight patients were followed up from 8 to 50 months with median follow-up period 17 months. The 1 and 2 year survival rates were 58%(22 cases) and 40%(15 cases), respectively. The mean survival time was 13 months. Primary carcinoma differentiation degree, onset time, number of metastasis, diameter as well as existence of metastasis capsule were related to 1 and 2 years survival rates(all in P<0.05). Conclusions Simultaneous liver resection or CRS plus later liver resection group are both safe and effective for hepatic metastasis of ovarian cancer. The differentiation grade of primary tumor, onset time, number of metastasis, diameter as well as existence of metastasis capsule are the main prognostic factors. Key words: Ovarian cancer; Hepatic metastasis; Hepatectomy; Cytoreductive surgery; Prognosis; Curative effect