Outcome of liver resection in breast cancer liver metastases

Abstract

Introduction Women with visceral metastases of breast cancer are usually considered to have a poor prognosis. A small subgroup of patients, however, present with liver metastases as the only manifestation of recurrence. The discussion whether this subgroup might benefit from an aggressive approach including liver resection is still ongoing and remains controversial. The decrease in mortality and morbidity rates has led to a broadening of the indication for hepatic resection. Design This was a case series study. Methodology Between January 2011 and December 2013, nine adult female patients underwent liver resection for liver metastases from breast cancer. Patients were considered for surgical management if they were fit for major operation; hepatic resection can be performed with adequate residual liver volume, intact inflow and outflow, and biliary drainage, and no extrahepatic disease on preoperative imaging except for limited and stable bone metastases. Hepatic resection was performed using standard techniques for either anatomic or nonanatomic resection. The type and length of the surgical procedures, intraoperative blood loss and transfusion, postoperative complications, ICU stay, and hospital stay were recorded. These patients were followed up in clinic 2 weeks postoperatively to record early postoperative complications. At subsequent follow-up visits every 3 months, chest radiography, abdominal ultrasound, and evaluation of carcinoembryonic antigen and CA 15-3 were carried out. Triphasic computed tomography of the abdomen was performed every 6 months and bone scan was performed case by case according to the patient's complain. The follow-up period was 2 years. Results All patients underwent tumorectomy with safety margins, except for two cases for which combined segmentectomy and tumorectomy with safety margins was performed. All patients underwent R0-resections. The mean operating time for hepatic resection was 150 ΁ 17 min, and blood loss was 360 ΁ 95 ml. Six patients were admitted to the ICU for 1 day and the main hospital stay was 5 ΁ 2 day. There was an overall morbidity rate of 33%, with one patient (11%) had grade 1 complication and two patients (22%) had grade 2 complications according to Clavien-Dindo score, and no postoperative mortality was detected. The mean follow-up period was 21 ΁ 2.7 months. One patient was presented with disease recurrence in the liver and brain at 8 months, and died at 10 months postoperatively (1-year survival, 88%). A second patient had local breast recurrence and died at 19 months postoperatively (2 years survival, 77%). Conclusion This approach represents a valid cytoreductive procedure for many patients with isolated liver metastases and may be curative for some of them. This benefit was obtained with a low morbidity rate and no mortality.