Author(s): Pocard M, Pouillart P, Asselain B, Falcou MC, Salmon RJ
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Abstract STUDY AIM: To report results of liver resections for breast cancer liver metastasis (BCLM) and to evaluate the rate of survival and the prognostic factors. PATIENTS AND METHOD: Between 1988 and 1999, 69 patients were operated on for BCLM and 65 who had liver resection were analyzed. The selection criteria for surgery were: normal performance status and liver function test; radiological objective response to chemotherapy (and/or hormonotherapy); in cases of non-isolated BCLM, complete response of associated metastatic site (usually bone) and no brain metastases. The mean age of the 65 patients was 47 (30-70) years. BCLM was diagnosed an average of 60 (0-205) months after the initial cancer. The BCLM was more frequently solitary (n = 44). The mean diameter was 3.8 (0-12) cm. The mean number of cycles of chemotherapy before surgery was 7.5 (3-24). Liver resections included major hepatectomy (n = 31): right n = 19, extended left n = 4, left n = 8, minor hepatectomy (n = 25) and limited resection (n = 9). RESULTS: There was no postoperative mortality. The 18\% morbidity rate included a majority of pleural effusions with two reoperations. The median follow-up was 41 months (6-100 months). The survival rate after surgery was 90\% at 1 year, 71\% at 3 and 46\% at 4 years. Thirteen patients are alive at 4 years. The 36-month survival rate differed according to the time to onset of BCLM: 55\% before versus 86\% after 48 months (p = 0.01). The other studied factors were not statistically associated with survival. The recurrence rate in the remaining liver at 36 months differed according to the lymph node status of the initial breast cancer: 40\% for N0-N1 versus 81\% for N1b-N2 (p = 0.01) and according to the type of liver resection: 45\% for minor liver resection versus 73\% for major (p = 0.02). CONCLUSION: Adjuvant liver surgery should be included in multicenter treatment protocols for medically-controlled breast cancer liver metastasis.
This article was published in Ann Chir
and referenced in Journal of Cancer Clinical Trials