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

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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.

Original languageEnglish (US)
Pages (from-to)1345-1354
Number of pages10
JournalWorld Journal of Surgery
Volume35
Issue number6
DOIs
StatePublished - Jun 1 2011

ASJC Scopus subject areas

  • Surgery

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    Kamel, S. I., De Jong, M. C., Schulick, R. D., Diaz-Montes, T. P., Wolfgang, C. L., Hirose, K., Edil, B. H., Choti, M. A., Anders, R. A., & 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