Long term survival and outcome of surgery in Breast Cancer Liver Metastases - is resection feasible?

Abstract

1. Breast cancer remains the most frequently diagnosed malignant disease in women and is the main female cancer-related cause of death. About 10 % of patients present with metastatic disease at diagnosis, and about 30 % of patients will develop metastases at a later time. In about half of these, metastatic spread occurs more than five years after initial diagnosis, with liver metastases (BCLM) being the third most frequent site. The Results of systemic and hormonal therapy alone for BCLM rarely show a complete response and remain a palliative therapeutic strategy. 2. We analyzed the outcome of 28 female patients evaluated for liver resection for BCLM from 1999 to 2018 in our clinic. Statistics were performed in SPSS. 3. Median age at initial diagnosis was 48 (33-75). 86 % developed metachronous metastases, median time between initial diagnosis and development of metastases was 5 yrs. (1-25 yrs.). 28,6 % had also extrahepatic metastases at the time of BCLM diagnosis (osseus, pulmonal, cerebral). 35,8 % of patients underwent minor resection (< 4 segments, wedge resections), while 50 % underwent major hepatic resection (4 segments or more). Four patients (14,3 %) showed disseminated disease intraoperatively and no resection was performed. Median overall survival was 38 months, 5-year OS 34,4 % and 3-year OS 59 %. 4. Surgical resection of BCLM is controversially discussed due to the lack of randomized controlled trials proving the benefit. However, there are retrospective studies reporting a prolonged OS and disease-free survival in BCLM patients. Our cohort was quite heterogeneous, with varying systemic treatment over a long time span. Still, our Results show an acceptable long-term survival. Patients with technically resectable BCLM should be considered for resection as part of a multi-disciplinary therapeutic approach.