Non-Colorectal Liver Metastases - Where Are the Limits of a Reasonable Aggressive Surgical Approach in the Multimodal Treatment Scheme?

Abstract

Background: Resection of non-colorectal liver metastases (NCRLM) is one of the recent fields in hepatic surgery. It was just 10-12 years ago when those procedures were totally denied as `risky` and `useless` and therefore, they were performed as an exception. Aim: The aim of this paper is to present analyses of early and late postoperative results in our series of resections of NCRLM, discussion of the indications for surgery and evaluation of the possible benefit of surgery as an element of multimodal treatment scheme. Materials and Methods: The study design was a single-center retrospective and prospective for a 9-year period (January 1, 2007-December 31, 2015). A total of 62 patients received R0 resections of metachronous and synchronous NCRLM. Metastatic pancreatic and gastric cancer cases predominated (n=49, 80.3%). The indications for aggressive surgery included age ≤ 60(65) years, absence of serious concomitant diseases, ASA ≤ III, no data of other distant organ involvement, no peritoneal lesions, no local recurrence (in metachronous cases) and resectable primary tumor (in synchronous cases). The early postoperative results were analyzed and outpatient follow-up was done every 3 months. Disease-free survival (DFS) and overall survival (OAS) rates were studied. Results: The early postoperative mortality rate was 4.2% in the whole series (2 fatal outcomes in gastric and 1 in pancreatic NCRLM). The specific morbidity rate was very high (N=33, 54.1%) and more often ascertained after multivisceral resections of synchronous NCRLM but 84.8% of them were treated by conservative or interventional methods. Reoperation was performed on 5 patients (15.2%). Fifty-six patients (91.8%) were followed for ≥12 months or until the patient`s death was registered. DFS (8.9-22.4 months) and OAS rates (10.7-57.3 months) varied in broad range and demonstrated statistical dependence on the primary tumor location, time of detection and „N`, „G` and `R` categories. Conclusion: Indicated and reasonable resections of synchronous and metachronous NCRLM had morbidity and mortality rates comparable to that of other multivisceral resections and they lead to a positive impact on the survival rates and the quality of life.