The role of liver-directed surgery in patients with Hepatic metastasis from a gynecologic primary carcinoma

Sarah I. Kamel, Mechteld C. De Jong, Richard D. Schulick, Teresa P. Diaz-Montes, Christopher L. Wolfgang, Kenzo Hirose, Barish H. Edil, Michael A. Choti, Robert A. Anders, Timothy M. Pawlik

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: The management of patients with liver metastasis from a gynecologic carcinoma remains controversial, as there is currently little data available. We sought to determine the safety and efficacy of liver-directed surgery for hepatic metastasis from gynecologic primaries. Methods: Between 1990 and 2010, 87 patients with biopsy-proven liver metastasis from a gynecologic carcinoma were identified from an institutional hepatobiliary database. Fifty-two (60%) patients who underwent hepatic surgery for their liver disease and 35 (40%) patients who underwent biopsy only were matched for age, primary tumor characteristics, and hepatic tumor burden. Clinicopathologic, operative, and outcome data were collected and analyzed. Results: Of the 87 patients, 30 (34%) presented with synchronous metastasis. The majority of patients had multiple hepatic tumors (63%), with a median size of the largest lesion being 2.5 cm. Of those patients who underwent liver surgery (n = 52), most underwent a minor hepatic resection (n = 44; 85%), while 29 (56%) patients underwent concurrent lymphadenectomy and 45 (87%) patients underwent simultaneous peritoneal debulking. Postoperative morbidity and mortality were 37% and 0%, respectively. Median survival from time of diagnosis was 53 months for patients who underwent liver-directed surgery compared with 21 months for patients who underwent biopsy alone (n = 35) (p = 0.01). Among those patients who underwent liver-directed surgery, 5-year survival following hepatic resection was 41%. Conclusions: Hepatic surgery for liver metastasis from gynecologic cancer can be performed safely. Liver surgery may be associated with prolonged survival in a subset of patients with hepatic metastasis from gynecologic primaries and therefore should be considered in carefully selected patients.

Original languageEnglish (US)
Pages (from-to)1345-1354
Number of pages10
JournalWorld Journal of Surgery
Volume35
Issue number6
DOIs
StatePublished - Jun 2011

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Neoplasm Metastasis
Carcinoma
Liver
Biopsy
Survival
Neoplasms
Tumor Burden
Lymph Node Excision
Liver Diseases
Databases
Morbidity
Safety
Mortality

ASJC Scopus subject areas

  • Surgery

Cite this

Kamel, S. I., De Jong, M. C., Schulick, R. D., Diaz-Montes, T. P., Wolfgang, C. L., Hirose, K., ... Pawlik, T. M. (2011). The role of liver-directed surgery in patients with Hepatic metastasis from a gynecologic primary carcinoma. World Journal of Surgery, 35(6), 1345-1354. https://doi.org/10.1007/s00268-011-1074-y

The role of liver-directed surgery in patients with Hepatic metastasis from a gynecologic primary carcinoma. / Kamel, Sarah I.; De Jong, Mechteld C.; Schulick, Richard D.; Diaz-Montes, Teresa P.; Wolfgang, Christopher L.; Hirose, Kenzo; Edil, Barish H.; Choti, Michael A.; Anders, Robert A.; Pawlik, Timothy M.

In: World Journal of Surgery, Vol. 35, No. 6, 06.2011, p. 1345-1354.

Research output: Contribution to journalArticle

Kamel, SI, De Jong, MC, Schulick, RD, Diaz-Montes, TP, Wolfgang, CL, Hirose, K, Edil, BH, Choti, MA, Anders, RA & Pawlik, TM 2011, 'The role of liver-directed surgery in patients with Hepatic metastasis from a gynecologic primary carcinoma', World Journal of Surgery, vol. 35, no. 6, pp. 1345-1354. https://doi.org/10.1007/s00268-011-1074-y
Kamel, Sarah I. ; De Jong, Mechteld C. ; Schulick, Richard D. ; Diaz-Montes, Teresa P. ; Wolfgang, Christopher L. ; Hirose, Kenzo ; Edil, Barish H. ; Choti, Michael A. ; Anders, Robert A. ; Pawlik, Timothy M. / The role of liver-directed surgery in patients with Hepatic metastasis from a gynecologic primary carcinoma. In: World Journal of Surgery. 2011 ; Vol. 35, No. 6. pp. 1345-1354.
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abstract = "Background: The management of patients with liver metastasis from a gynecologic carcinoma remains controversial, as there is currently little data available. We sought to determine the safety and efficacy of liver-directed surgery for hepatic metastasis from gynecologic primaries. Methods: Between 1990 and 2010, 87 patients with biopsy-proven liver metastasis from a gynecologic carcinoma were identified from an institutional hepatobiliary database. Fifty-two (60{\%}) patients who underwent hepatic surgery for their liver disease and 35 (40{\%}) patients who underwent biopsy only were matched for age, primary tumor characteristics, and hepatic tumor burden. Clinicopathologic, operative, and outcome data were collected and analyzed. Results: Of the 87 patients, 30 (34{\%}) presented with synchronous metastasis. The majority of patients had multiple hepatic tumors (63{\%}), with a median size of the largest lesion being 2.5 cm. Of those patients who underwent liver surgery (n = 52), most underwent a minor hepatic resection (n = 44; 85{\%}), while 29 (56{\%}) patients underwent concurrent lymphadenectomy and 45 (87{\%}) patients underwent simultaneous peritoneal debulking. Postoperative morbidity and mortality were 37{\%} and 0{\%}, respectively. Median survival from time of diagnosis was 53 months for patients who underwent liver-directed surgery compared with 21 months for patients who underwent biopsy alone (n = 35) (p = 0.01). Among those patients who underwent liver-directed surgery, 5-year survival following hepatic resection was 41{\%}. Conclusions: Hepatic surgery for liver metastasis from gynecologic cancer can be performed safely. Liver surgery may be associated with prolonged survival in a subset of patients with hepatic metastasis from gynecologic primaries and therefore should be considered in carefully selected patients.",
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AU - Schulick, Richard D.

AU - Diaz-Montes, Teresa P.

AU - Wolfgang, Christopher L.

AU - Hirose, Kenzo

AU - Edil, Barish H.

AU - Choti, Michael A.

AU - Anders, Robert A.

AU - Pawlik, Timothy M.

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N2 - Background: The management of patients with liver metastasis from a gynecologic carcinoma remains controversial, as there is currently little data available. We sought to determine the safety and efficacy of liver-directed surgery for hepatic metastasis from gynecologic primaries. Methods: Between 1990 and 2010, 87 patients with biopsy-proven liver metastasis from a gynecologic carcinoma were identified from an institutional hepatobiliary database. Fifty-two (60%) patients who underwent hepatic surgery for their liver disease and 35 (40%) patients who underwent biopsy only were matched for age, primary tumor characteristics, and hepatic tumor burden. Clinicopathologic, operative, and outcome data were collected and analyzed. Results: Of the 87 patients, 30 (34%) presented with synchronous metastasis. The majority of patients had multiple hepatic tumors (63%), with a median size of the largest lesion being 2.5 cm. Of those patients who underwent liver surgery (n = 52), most underwent a minor hepatic resection (n = 44; 85%), while 29 (56%) patients underwent concurrent lymphadenectomy and 45 (87%) patients underwent simultaneous peritoneal debulking. Postoperative morbidity and mortality were 37% and 0%, respectively. Median survival from time of diagnosis was 53 months for patients who underwent liver-directed surgery compared with 21 months for patients who underwent biopsy alone (n = 35) (p = 0.01). Among those patients who underwent liver-directed surgery, 5-year survival following hepatic resection was 41%. Conclusions: Hepatic surgery for liver metastasis from gynecologic cancer can be performed safely. Liver surgery may be associated with prolonged survival in a subset of patients with hepatic metastasis from gynecologic primaries and therefore should be considered in carefully selected patients.

AB - Background: The management of patients with liver metastasis from a gynecologic carcinoma remains controversial, as there is currently little data available. We sought to determine the safety and efficacy of liver-directed surgery for hepatic metastasis from gynecologic primaries. Methods: Between 1990 and 2010, 87 patients with biopsy-proven liver metastasis from a gynecologic carcinoma were identified from an institutional hepatobiliary database. Fifty-two (60%) patients who underwent hepatic surgery for their liver disease and 35 (40%) patients who underwent biopsy only were matched for age, primary tumor characteristics, and hepatic tumor burden. Clinicopathologic, operative, and outcome data were collected and analyzed. Results: Of the 87 patients, 30 (34%) presented with synchronous metastasis. The majority of patients had multiple hepatic tumors (63%), with a median size of the largest lesion being 2.5 cm. Of those patients who underwent liver surgery (n = 52), most underwent a minor hepatic resection (n = 44; 85%), while 29 (56%) patients underwent concurrent lymphadenectomy and 45 (87%) patients underwent simultaneous peritoneal debulking. Postoperative morbidity and mortality were 37% and 0%, respectively. Median survival from time of diagnosis was 53 months for patients who underwent liver-directed surgery compared with 21 months for patients who underwent biopsy alone (n = 35) (p = 0.01). Among those patients who underwent liver-directed surgery, 5-year survival following hepatic resection was 41%. Conclusions: Hepatic surgery for liver metastasis from gynecologic cancer can be performed safely. Liver surgery may be associated with prolonged survival in a subset of patients with hepatic metastasis from gynecologic primaries and therefore should be considered in carefully selected patients.

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