Einstein (São Paulo) (Mar 2008)
Hepatic resection for non-colorectal and non-neuroendocrine metastatic cancer: indications and results in ten resectable cases
Abstract
Objective: To report the early postoperative results and long-termsurvival on ten patients undergoing hepatectomy for treatmentof non-colorectal and non-neuroendocrine hepatic metastases.The study was carried out by the General Surgery Service of theDepartment of Digestive Tract Surgery of the Teaching Hospital ofthe Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil.Methods: Complete follow-up data were available on 28 patientswith hepatic metastases who were operated on between January2002 and January 2007. Ten patients presented non-colorectal andnon-neuroendocrine primary neoplasms, and comprised the sampleof this study. There were five males and five females, mean age of53 years (28 to 68 years). The right lobe was involved in five patientsand the left lobe in five individuals. The number of metastasesranged from one to four. All metastases were unilateral. All primarytumors were identified. The histological types were adenocarcinoma(n = 7), germinative tumor (n = 1), melanoma (n = 1) and sarcoma(n = 1). The primary sites were: gastric (n = 1), kidney (n = 1),adrenal (n = 1), breast (n = 2), testicle (n = 1), ovary (n = 2),acral melanoma (n = 1) and retroperitoneal sarcoma (n = 1). Allpatients presented metachronous metastases. The median intervalbetween primary tumor treatment and diagnosis of metastases was20 months (12 to 33 months). Six patients received chemotherapyand four patients underwent exclusively surgical treatment. Results:There were seven major hepatic resections (three or more Couinaudsegments) and three minor hepatic resections. The operative timevaried from 180 to 425 minutes with a median duration of 240minutes. Five patients received transfusions; blood loss ranged from200 to 3,000 ml. There were two postoperative complications andboth patients were re-operated (biliary fistula = 1; intra-abdominalabscess = 1). There were no postoperative deaths. All resectionswere R0. The three-year overall survival rate was 50%. Five patientsdeveloped tumor recurrence (50%). Conclusions: Hepatic resectionfor liver metastases other than of colorectal or neuroendocrine originpresents acceptable morbidity and no mortality. This approach mayresult in long-term survival in this group of patients.
