Results of hepatic resection for sarcoma metastatic to liver

Abstract

Objective: To evaluate the outcome of patients with liver metastases from sarcoma who underwent hepatic resection at a single institution and were followed up prospectively.

Summary background data: The value of hepatic resection for metastatic sarcoma is unknown.

Methods: There were 331 patients with liver metastases from sarcoma who were admitted to Memorial Hospital from 1982 to 2000, and 56 of them underwent resection of all gross hepatic disease. Patient, tumor, and treatment variables were analyzed to assess outcome.

Results: Of the 56 patients who underwent complete resection, 34 (61%) had gastrointestinal stromal tumors or gastrointestinal leiomyosarcomas. Half of the patients required an hepatic lobectomy or extended lobectomy. There were no perioperative deaths in the completely resected group, although 3 of the 75 patients who underwent exploration (4%) died. The postoperative 1-, 3-, and 5-year actuarial survival rates were 88%, 50%, and 30%, respectively, with a median of 39 months. In contrast, the 5-year survival rate of patients who did not undergo complete resection was 4%. On multivariate analysis, a time interval from the primary tumor to the development of liver metastasis greater than 2 years was a significant predictor of survival after hepatectomy.

Conclusions: Complete resection of liver metastases from sarcoma in selected patients is associated with prolonged survival. Hepatectomy should be considered when complete gross resection is possible, especially when the time to the development of liver metastasis exceeds 2 years.

Figure 1. Effect of treatment on disease-specific survival in the entire population. The 56 patients (upper line) with liver metastases from sarcoma who underwent complete resection of all gross disease had significantly longer survival than the 275 patients (lower line) who underwent other treatment (P < .0001).

Figure 2. Relationship of tumor histology to survival in patients undergoing complete resection. The 34 patients (solid line) with gastrointestinal stromal tumor (GIST) or gastrointestinal leiomyosarcoma (GI LMS) had similar survival to the 22 patients (broken line) with other types of sarcoma (P = .72).

Figure 3. Relationship of the timing of liver metastasis to outcome in patients undergoing complete resection. The 32 patients (upper line) who developed liver metastases more than 2 years after the primary tumor had prolonged survival compared with the 24 patients (lower line) with a shorter duration to liver metastasis (P = .002).

Figure 4. Disease-free survival in 56 patients who underwent complete resection. The median disease-free survival in the patients who underwent complete resection was 32 months, and the 5-year disease-free survival rate was 20%.