Non-neuroendocrine Liver Metastases Research Articles

Comparison of post-hepatectomy long-term survival outcome between non-colorectal non-neuroendocrine and colorectal liver metastases: A population-based propensity-score matching analysis

BackgroundHepatectomy is an established treatment for colorectal liver metastasis (CLM) or neuroendocrine liver metastasis. However, its role in non-colorectal non-neuroendocrine liver metastasis (NCNNLM) is controversial. This study aims to compare long-term survival outcomes after hepatectomy between NCNNLM and CLM in a population-based cohort. MethodsFrom 2009 to 2018, curative hepatectomy were performed in 964 patients with NCNNLM (n ​= ​133) or CLM (n ​= ​831). Propensity score (PS) matching was performed. Short-term and long-term outcomes were compared between PS-matched groups. Univariate and multivariate analyses were performed to identify prognostic factors affecting survival. ResultsThere were 133 patients in the NCNNLM group and 266 patients in the CLM group. The mortality (1.5 ​% vs 1.5 ​%) and morbidity (19.5 ​% vs 20.3 ​%) rates were comparable between the two groups. There was no statistically significant difference in 5-year overall (48.9 ​% vs 39.8 ​%) and recurrence-free (25.1 ​% vs 23.4 ​%) survival rates between NCNNLM and CLM groups. A high pre-operative serum bilirubin level, severe postoperative complications and multiple tumors were independent prognostic factors for poor survival. ConclusionHepatectomy for selected patients with NCNNLM can achieve similar long-term oncological outcomes as those with CLM. High serum bilirubin, severe postoperative complication and multiple tumors are poor prognostic factors for survival.

Non-colorectal liver metastases: A review of interventional and surgical treatment modalities.

Liver metastases (LM) occur in up to 90% either simultaneously with the diagnosis of the primary tumor or at a later time-point. While resection of colorectal LM and resection or transplantation of neuroendocrine LM is part of a standard therapy with a 5-year patient survival of up to 80%, resection of non-colorectal and non-neuroendocrine LM is still discussed controversially. The reason for it is the significantly lower survival benefit of all different tumor entities depending on the biological aggressiveness of the tumor. Randomized controlled trials are lacking. However, reviews of case series with ≥100 liver resections are available. They show a 5-year patient survival of up to 42% compared to only <5% in patients without treatment. Risk factors for poor survival include the type of primary tumor, a short interval between resection of the primary tumor and liver resection, extrahepatic manifestation of the tumor, number and size of the LM, and extent of liver resection. Overall, it has recently been shown that a good patient selection, the technical advances in surgical therapy and the use of a risk score to predict the prognosis lead to a significantly better outcome so that it is no longer justified not to offer liver resection to patients with non-colorectal, non- endocrine LM. Since modern therapy of LM is multimodal, the optimal therapeutic approach is decided individually by a multidisciplinary team consisting of visceral surgeons, oncologists, interventional radiologists and radiologists as part of a tumor board.

Non-colorectal non-neuroendocrine liver metastasis: a narrative review of surgical treatment.

The liver is the main site of metastatic disease, and cancer metastases remain the main limit to successfully managing the malignant disease. Liver resection (LR) for the treatment of metastatic cancer has been described for over a hundred years and is widely accepted. The role of surgery in managing non-colorectal non-neuroendocrine liver metastasis (NCNNLM), evidence is still lacking due to different factors: the paucity of cases, the wide variety of histological subtypes of the primary disease and its biological behavior, and the absence of prospective studies. We performed a narrative review of peer-reviewed articles related to the surgical outcomes of NCNNLM. The aim of this review is determining the utility of surgery in NCNNLM, with attention to minimal invasive LRs. We analyzed the role of LR for NCNNLM according to the different cancers: digestive and non digestive. NCNNLM encompass a huge spectrum of histologic appearances. LR for limited NCNNLM may offer a curative option, but liver recurrence occurs frequently. Our ability to significantly predict the outcome is poor. The cytotoxic chemotherapy and biologic agents have significantly altered the surgical treatment of LM. The latter treatments can convert inoperable patients into operable ones, with a clear relationship between the degree of resectability in patients judged inoperable at referral and the rate of response to the treatment scheme.

Surgical management of noncolorectal, nonneuroendocrine liver metastases

Surgical management of noncolorectal, nonneuroendocrine liver metastases

Histopathological growth patterns of resected non-colorectal, non-neuroendocrine liver metastases: a retrospective multicenter study.

Distinct Histopathological Growth Patterns can be identified in liver metastases from melanoma, breast and colorectal cancers. For each of these distinct liver metastasis types the HGP has proven a biomarker for survival after partial hepatectomy, with the desmoplastic type marking favourable prognosis. Whether HGPs can be considered a pan-cancer phenomenon remains unknown. This study therefore evaluates the presence of HGPs and their prognostic value across non-colorectal non-neuroendocrine liver metastases. A retrospective multicentre cohort study was performed in patients who underwent curative intent resection of non-colorectal non-neuroendocrine liver metastasis. HGPs were assessed on Haematoxylin and Eosin slides according to consensus guidelines and classified as desmoplastic or non-desmoplastic. Overall- and recurrence-free survival were evaluated using Kaplan-Meier and multivariable Cox regression analysis. In total, 132 patients with liver metastasis from 25 different tumour types were eligible for analysis, of which 26 (20%) had a desmoplastic HGP. Five-year OS and RFS (95%CI) were 53% (36-78%) versus 40% (30-53%), and 33% (19-61%) versus 15% (9-27%) for patients with desmoplastic compared to non-desmoplastic metastases, respectively (p = 0.031 & p = 0.004). On multivariable analysis (adjusted HR [95%CI]) a desmoplastic HGP was prognostic for both OS (0.46 [0.25-0.86]) and RFS (0.38 [0.21-0.69]). This study demonstrates that HGPs apply to liver metastases across a wide variety of primary tumour origins. They hold a prognostic value in these cases, suggesting that HGPs could represent a pan-cancer biomarker for survival after surgical resection of liver metastases.

Histopathological Growth Patterns of Resected Non-colorectal, Non-neuroendocrine Liver Metastases: A Retrospective Multicenter Study

Introduction: Distinct Histopathological Growth Patterns (HGPs) can be identified in liver metastases originating from melanoma, breast- and colorectal cancer. HGPs are related to survival after resection. A desmoplastic HGP, characterized by a desmoplastic ring separating the tumour cells from the liver parenchyma, marks good prognosis for each of these tumours. Whether HGPs extend to other tumour types and can be considered a pan-cancer phenomenon remains unknown. This study evaluates the presence of HGPs and their prognostic value in non-colorectal, non-neuroendocrine liver metastases. Methods: A retrospective multicentre study was performed in patients who underwent curative-intent resection of non-colorectal, non-neuroendocrine liver metastasis. HGPs were classified as desmoplastic or non-desmoplastic on H&E slides according to consensus guidelines. Overall- (OS) and recurrence free (RFS) survival were evaluated using Kaplan-Meier and multivariable Cox regression analysis. Results: In total, 132 patients with liver metastasis from 25 tumour types (95 carcinoma, 9 sarcoma, 14 melanoma, 14 other) were considered eligible for analysis, of which 26 (20%) had a desmoplastic HGP. Five-year OS and RFS (95%CI) were 53% (36-78%) versus 40% (30-53%), and 33% (19-61%) versus 15% (9-27%) for desmoplastic compared to non-desmoplastic patients, respectively (p=0.031 & p=0.004, Figure 1). On multivariable analysis (HR [95%CI]) a desmoplastic HGP was prognostic for both OS (0.46 [0.25-0.86], p=0.01) and RFS (0.38 [0.21-0.69], p<0.01) (table 1). Conclusions: This study demonstrates that HGPs extend to a variety of liver metastatic tumours and suggests that the desmoplastic HGP is a pan-cancer biomarker for good survival after surgical resection of liver-metastasis. Figure. Tabled 1Table. Uni-and Multivariable Cox regression for OS and RFSOverall SurvivalUnivariatepMV (n=124)pProgression Free SurvivalUnivariatepMV (n=119)pChemotherapyReference-Reference-ChemotherapyReference-Reference-No ChemotherapyNo ChemotherapyNeoadjuvant0.90 [0.52-1.53]0.690.98 [0.56-1.74]0.96Neoadjuvant0.71 [0.43-1.15]0.160.75 [0.45-1.25]0.26Adjuvant3.93 [0.92-16.80]0.065.49 [1.18-25.46]0.03Adjuvant1.73 [0.41-7.27]0.452.83 [0.63-12.78]0.18Neoadjuvant and adjuvant1.16 [0.63-2.14]0.631.14 [0.59-2.18]0.7Neoadjuvant and adjuvant1.17 [0.68-2.02]0.561.31 [0.73-2.35]0.37Nr. LM (multiple)1.44 [0.89-2.31]0.141.33 [0.80-2.21]0.27Nr. LM (Multiple)1.34 [0.87-2.09]0.191.25 [0.77-2.01]0.36Adam Score1.15 [0.98-1.35]0.091.21 [1.04-1.42]0.02Adam Score1.15 [0.99-1.35]0.071.27 [1.08-1.48]<0.01HGP (Non-desmoplastic)0.52 [0.28-0.95]0.030.51 [0.27-0.95]0.04HGP (Non-desmoplastic)0.44 [0.25-0.78]<0.010.38 [0.21-0.71]<0.01 Open table in a new tab

Surgical treatment of liver metastases from non-colorectal non-neuroendocrine carcinomas

IntroductionIn the literature, results after surgical treatment of non-colorectal non-neuroendocrine liver metastases (NCNNLM) are reported that are often inferior to those from colorectal liver metastases. The selection of patients with favorable tumor biology is currently still a matter of discussion.Materials/methodsThe retrospective data analysis was based on data that were collected for the multicenter study “Role of surgical treatment for non-colorectal liver metastases” in county Thuringia.ResultsFor the study, 637 patients were included from 1995 to 2018. 5 and 10-year survival of R0 resected patients were 33% and 19%, respectively. In the multi-variate analysis of the entire group, sex, timing, disease-free interval, number of metastases, R-classification as well as lymph node status of the primary lesion showed an independent statistical influence on the 5-year survival. In the group of R0 resected patients, disease-free interval, number of metastases and lymph node status of the primary lesion influenced the 5-year survival in the multi-variate analysis. In kidney malignancies, R-classification, timing and number of liver metastases were statistically significant in the multi-variate analysis of the 5-year survival, in mamma carcinomas only the R-classification.ConclusionThe Adam score identifies some risk factors which influence prognosis in most but not in all tumor entities. For kidney cancer and breast cancer it can be simplified.

Is resection for noncolorectal, nonneuroendocrine liver metastases justified?

The role of hepatectomy in non-colorectal, nonneuroendocrine liver metastasis (NCNN) is not clearly defined. This study represents a step towards surgical frame-shift as an integral part of treatment pathway in these heterogeneous, arbitrarily treated tumors. It aims to provide answers regarding favorable tumor types and patient profiles for which liver metastasectomy would prove beneficial. Retrospective analysis of prospectively maintained database of hepatectomy in NCNN liver metastasis. A total of 50 patients out of 516 patients underwent liver resection during this period. In 27 patients, the liver metastases presented synchronously whereas the other 23 were metachronous. Median disease-free interval (DFI) was 36 months. Gastrointestinal stromal tumors (GIST) were the most common type of primary malignancy (15, 30%). In 41 patients, the liver was the only site of metastases. At a median follow-up of 32.5 months, 24 patients developed recurrences. Five-year overall (OS) and disease-free survival (DFS) for the entire cohort was 60% and 32%, respectively. Median OS was highest in the breast (93 months) followed by GIST (56 months). Patients with longer DFI showed improved OS. (p = .04). Liver resection for NCNN metastases is safe and feasible in selected patients with good survival outcomes. Longer DFI correlates with better survival.

The lack of selection criteria for surgery in patients with non-colorectal non-neuroendocrine liver metastases

BackgroundThe benefit of surgery in patients with non-colorectal non-neuroendocrine liver metastases (NCRNNELM) remains controversial. At the population level, several statistical prognostic factors and scores have been proposed but inconsistently verified. At the patient level, no selection criteria have been demonstrated to guide individual therapeutic decision making. We aimed to evaluate potential individual selection criteria to predict the benefit of surgery in patients undergoing treatment for NCRNNELM.MethodsData for 114 patients undergoing surgery for NCRNNELM were reviewed. In this population, we identified an early relapse group (ER), defined as patients with unresectable recurrence < 1 year postoperatively who did not benefit from surgery (N = 28), and a long-term survival group (LTS), defined as patients who were recurrence-free ≥ 5 years postoperatively and benefited from surgery (N = 20). Clinicopathologic parameters, the Association Française de Chirurgie (AFC) score, and a modified 4-point Clinical Risk Score (mCRS) (excluding CEA level) were analyzed and compared between LTS and ER groups.ResultsThe majority of patients were female and a majority had an ASA score ≤ 2 at the time of liver surgery. The median age was 55 years. Almost half of the patients (46%) presented with a single-liver metastasis. Intermediate- and low-risk AFC scores represented 40% and 60% of the population, respectively. Five- and 10-year overall survival (OS) and disease-free survival (DFS) rates were 56% and 27%, and 30% and 12%, respectively. Negative prognostic factors were the size of liver metastases > 50 mm and delay between primary and NCRNNELM <24 months for OS and DFS, respectively. AFC score was not prognostic while high-risk mCRS (scores 3–4) was predictive for the poorer OS. The clinicopathologic parameters were similar in the ER and LTS groups, except the presence of N+ primary tumor, and the size of liver metastases was significantly higher in the ER group.ConclusionIn patients with resectable NCRNNELM, no predictive factors or scores were found to accurately preoperatively differentiate individual cases in whom surgery would be futile from those in whom surgery could be associated with a significant oncological benefit.

Surgical tactic for non-colorectal and non-neuroendocrine liver metastases

Surgical tactic for non-colorectal and non-neuroendocrine liver metastases

Outcomes of 1,639 hepatectomies for non-colorectal non-neuroendocrine liver metastases: a multicenter analysis.

Whether non-colorectal non-neuroendocrine liver metastasis (NCNNLM) should be treated surgically remains unclear. Data regarding 1,639 hepatectomies performed between 2001 and 2010 for 1,539 patients with NCNNLM were collected from 124 institutions. Patient characteristics, types of primary tumor, characteristics of liver metastases, and post-hepatectomy outcomes were analyzed. The five most frequent primary tumors were gastric carcinoma (540 patients [35%]), gastrointestinal stromal tumor (204 patients [13%]), biliary carcinoma (150 patients [10%]), ovarian cancer (107 patients [7%]), and pancreatic carcinoma (77 patients [5%]). R0/1 hepatectomy was achieved in 90% of patients, with 1.5% in-hospital mortality rate. Overall and disease-free survival rates of 1,465 patients included in survival analysis were 41% and 21%, respectively, at 5years, and 28% and 15%, respectively, at 10years. Five-year survival associated with the five frequent primary tumors were 32%, 72%, 17%, 52%, and 31%, respectively, and factors predictive of a poor outcome differed by the primary tumor type. Our data indicated that hepatectomy is safe for NCNNLM and that patient prognoses vary depending on the type of primary tumors. Indications for hepatectomy should be determined with reference to survival rates and risk factors specific to each of the various types of primary tumor.

Outcome after hepatic resection for isolated non-colorectal, non-neuroendocrine liver metastases in 100 patients \u2013 the role of the embryologic origin of the primary tumor

BackgroundThe indication for hepatic resection (HR) in patients suffering from liver metastases (LM) other than colorectal and neuroendocrine tumors is one focus of current multidisciplinary, oncologic considerations. This study retrospectively analyzes outcome after HR for non-colorectal, non-neuroendocrine (NCNNE) LM in the absence of distant or extrahepatic metastases.MethodsWe included 100 consecutive patients undergoing HR for isolated NCNNE LM from a prospective database in our institution, including postoperative follow-up. Primary tumors were of mesodermal origin in 44%, of ectodermal origin in 29% and of entodermal origin in 27%. Survival analysis was performed by univariate and multivariable methods. Mean follow-up after hepatic surgery was 3.6 years (0.25–16).ResultsMedian age at the time of HR was 59.5 years. Kaplan-Meier-estimated survival after liver resection was 56.8%, 34.3% and 24.5% after 5, 10 and 15 years, respectively. Univariate analysis after HR revealed residual disease (hepatic or primary; p = 0.02), female gender (p = 0.013), entodermal origin (p = 0.009) and early onset of metastatic disease (≤24 months, p = 0.002), as negative prognostic factors. Multivariable survival analysis confirmed residual disease, female gender, entodermal embryologic origin and early onset of metastatic disease (≤24 months) as independent negative prognostic factors.ConclusionOverall outcome after HR of NCNNE LM results in acceptable long-term outcome. Although individual decision-making today mostly relies on clinical experience for this type of disease, risk factors derived from the embryologic origin of the tumor might help in patient selection.

Neoadjuvant chemotherapy response influences outcomes in non-colorectal, non-neuroendocrine liver metastases.

Indications for surgical resection of non-colorectal, non-neuroendocrine (NCNNE) liver metastases are unclear. This study analysed the influence of response to neoadjuvant chemotherapy and the presence of extrahepatic disease (EHD) on outcomes. Patients who underwent hepatic resection for NCNNE liver metastases and who received neoadjuvant chemotherapy at a single centre between 1982 and 2016 were analysed retrospectively. Patients were classified as having no EHD, controlled EHD or non-controlled EHD. Hepatic resection was performed in 199 patients (81·2 per cent) after partial or complete response to chemotherapy or disease stabilization, and 46 patients (18·8 per cent) after tumour progression. Patients with progressive disease after chemotherapy had worse overall survival than those without (23 versus 50·4 per cent at 5 years; P = 0·004). Median survival was 63·6 (range 31·1-94·8) months for patients without EHD, 34·8 (19·2-49·2) months for those with controlled EHD and 7·2 (1·2-13·2) months for patients with non-controlled EHD (P = 0·004). In multivariable analysis, EHD (P = 0·004), response to chemotherapy (P = 0·004) and resection margins (P = 0·002) were all independent predictors of overall survival, regardless of primary tumour site. The prognosis of patients with NCNNE liver metastases is influenced by preoperative chemotherapy and resectability.

Preoperative Prognostic Factors After Liver Resection for Non-Colorectal, Non-Neuroendocrine Liver Metastases and Validation of the Adam Score in an Asian Population.

Historically, the benefit of liver resection for non-colorectal, non-neuroendocrine (NCNN) liver metastases has been controversial. This study aims to determine the preoperative prognostic factors of liver resection for NCNN liver metastases and validate the Adam score in an Asian population. Consecutive patients who underwent liver resection for NCNN liver metastases were identified retrospectively from a prospective liver resection database of the single institution between 2001 and 2014. Univariate Cox regression models were used to identify associations with outcome variables. Recurrence-free interval and overall survival were determined using the Kaplan-Meier method and compared using log-rank test. Seventy-eight consecutive patients were identified, which met the study criteria. Univariate analysis demonstrated that adenocarcinoma histology of primary cancer, disease-free interval and number of nodules were significant predictors of survival. Four of the six components of Adam score were significant predictors of survival. These were the presence of extrahepatic metastases, R2 resection, disease-free interval and type of a primary tumour. The total Adam score was also a significant predictor of survival. Liver resection for NCNN liver metastases is a safe and viable treatment option in carefully selected patients. Significant preoperative prognostic factors include adenocarcinoma primary tumours, disease-free interval and number of nodules. The total Adam score was a good predictor of overall survival and can be used to risk stratify patients undergoing hepatic resection for NCNN liver metastases.

Single-center experience in the management of non-colorectal, non-neuroendocrine liver metastases: Metachronous resection as an independent prognostic factor

Single-center experience in the management of non-colorectal, non-neuroendocrine liver metastases: Metachronous resection as an independent prognostic factor

Margin status is a predictor of long-term survival following resection of non-colorectal, non-net liver metastases

Aims: The role of resectional surgery for colorectal liver metastases is well defined with improved 5-year survival rates. Non-colorectal, non-neuroendocrine liver metastases (NCNNLM) are not uncommonly encountered but the role of surgery is not yet clearly defined. This study is aimed to assess the immediate and long-term outcomes following liver resection for NCNNLM. Methods: Patients who underwent liver resection for NCNNLM between 2004 and 2014 were included from a prospectively maintained database at a tertiary referral centre. 90-day mortality, post-operative morbidity, disease-free (DFS) and overall survival (OS) were assessed. Univariable analyses were performed to identify predictors of survival. All analyses were performed using IBM SPSS 19 (IBM Corp. Armonk, NY), with p < 0.05 being statistically significant. Results: A total of 44 patients underwent 54 liver resections. Median age group was 54 years (range, 32–77 years). Metastases from breast (25%) and renal (15%) primaries were most commonly encountered. 19.3% were synchronous metastases. 90-day mortality and post-operative morbidity were 2% and 11% respectively. OS and DFS for NCNNLM at 1- year were 90% and 60% and at 5-years were 57% and 25% respectively. OS for breast and renal cancer at 1 year were 93% and 67% and at 5-years were 49% and 51% respectively. Positive resection margin has a significant influence on the OS (p = 0.018) on univariate analysis. Conclusions: Resection of liver metastases should be considered for NCNNLM as the survival rates are satisfactory. R0 resection remains an important determinant of overall survival.

Hepatectomy for liver metastases in non-colorectal, non-neuroendocrine cancer patients. The survival benefit in primary unresectable cases

BackgroundAlthough liver resection is widely accepted as a potentially curative treatment for colorectal liver metastases, there is an ongoing debate on the indications for hepatectomy for the treatment of liver metastases from non-colorectal primary tumors. The number of candidates for hepatectomy for non-colorectal liver metastases may increase due to advances in chemotherapy; however, the factors related to prognosis after hepatectomy for non-colorectal liver metastases have yet to be clearly elucidated. MethodsThe clinical outcomes of 59 patients who underwent hepatectomy for non-colorectal liver metastases at a single institute were retrospectively analyzed. ResultsThe 5-year overall survival rate after hepatectomy for non-colorectal, non-neuroendocrine liver metastases was 30%, and 8 patients (gastric cancer (n = 2), ovarian cancer (n = 2), uterine cancer (n = 2) and breast cancer (n = 2)) survived for 5 years. The 5-year disease-free survival rate after hepatectomy was 28%. The postoperative morbidity rate was 25%; however, there were no cases of in-hospital mortality and no patients suffered liver failure. The presence of bilateral liver metastases was identified to be an independent predicting factor for poor prognosis by a multivariate analysis (P = 0.049). The survival rate of the conversion cases (initially unresectable and converted to resection after chemotherapy) was not inferior to that of primary resectable cases in terms of either overall survival or disease-free survival. ConclusionThe present study demonstrates that hepatectomy for liver metastases from non-colorectal tumors is safe and that it may be a promising strategy for prolonging survival and achieving a cure.

METÁSTASIS HEPÁTICAS DE ORIGEN NO COLORRECTAL NI NEUROENDOCRINO: TRATAMIENTO EN UN HOSPITAL DE SEGUNDO NIVEL

liver metastases from non-colorectal non-neuroendocrine tumors. treatment in a hospital of second level introduction: Surgical treatment of liver metastases is broadly accepted for colorectal and neuroendo- crine tumors. However, the approach to liver metastases of other origins is not well established. The objective is the evaluation of factors that might be associated with better or worse perioperative outcomes (morbidity and mortality) and survival of patients with non-colorectal, non-neuroendocrine liver metastases (nCnnLM) treated surgically in a second level hospital. material and methods: A prospective study of patients with nCnnLM treated surgically or with radiofrequency was completed in San Cecilio University Hospital of Granada, between March 2003 and June 2013. The statistical analysis was made with IBM-SPSS version 21. Statistical significance was set at p ≤ 0.05. Survival data were analyzed by Kaplan-Meiers method. re- sults: Twenty-two patients with 26 surgeries were analyzed, 19 liver resections, 6 radiofrequency treatments and 1 combined case with surgery and radiofrequency. Operatory mortality was 0% and overage mortality was 23.1%. Univariate analysis only showed statistical significance in two of the factors, presence of positive lymphatic nodes during the surgery of the primary tumor and presence of extra-hepatic disease. Accumulated survival was 81%, 66% and 52% at 1, 2 and 3 years respectively. conclusions: Despite the fact of treating together in the same group several different tumors, the surgical treatment of nCnnLM (with or without radiofrequency) has an acceptable survival rate. Thus, they can be treated with safety when we use a multi- disciplinary approach to these patients.

Surgical Approach of Cervical Cancer Liver Metastases: Case Report

Cervical cancer is an aggressive malignancy with a high tendency of invasion of the surrounding organs and also with capacity to give birth to metastases on both lymphatic and hematogenous routes. Cases who present distant metastases at the moment of diagnosis are generally referred to the medical oncologist than to the surgeon; however increasing reports on the benefit of liver surgery in non-colorectal non-neuroendocrine liver metastases have decreased the general reluctance to perform radical visa surgery on such cases. We present the case of a 53 years old female diagnosed with cervical cancer and liver metastases in which a radical resection was performed with good oncologic outcomes.

The benefits of liver resection for non-colorectal, non-neuroendocrine liver metastases: a systematic review.

Defining the benefits of resection of isolated non-colorectal, non-neuroendocrine (NCRNNE) liver metastases is difficult. To better understand the survival benefit in this group of patients, we conducted a systematic review of the previous literature. Medline, Web of Knowledge, and manual searches were performed using search terms, such as "liver resection" and "primary tumor." Inclusion criteria were year>1990, >five patients, and median survival reported or derived. An expected median survival was calculated from weighted averages of median survivals, and differences were assessed using a permutation test. A total of 7,857 references were identified. Overall 4,735 abstracts were reviewed; 120 manuscripts evaluated and of these, 73 met the study inclusion criteria. The final population consisted of 3,596 patients with renal (n=234), ovarian (n=119), testicular (n=153), adrenal (n=90), small bowel (n=28), gallbladder (n=21), duodenum (n=38), gastric (n=481), pancreatic (n=55), esophageal (n=23), head and neck (n=15), and lung (n=36) cancers, gastrointestinal stromal tumors (GISTs) (n=106), cholangiocarcinoma (n=13), sarcoma (n=189), and melanoma (n=643). The greatest expected median was 63 months for genitourinary (GU) primaries (n=549; range 5.4-142 months) followed by 44.4 months for breast cancer (n=1,013; range 8-74 months), 22.3 months for gastrointestinal cancer (n=549; range 5-58 months), and 23.7 months for other tumor types (n=1,082; range 10-72 months). Using a permutation test, we observed that survival was best for patients with GU primaries followed by that for breast cancer patients. Additionally, we also observed that survival was similar for those with cancer of the GI tract and other primary sites. There appears to be a benefit to resection for patients with NCRNNE liver metastases. The degree of survival advantage is predicated by primary site.