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

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.

Fig. 1

Contrast-enhanced CT scans of a gynecologic primary tumor liver metastasis located (a) on the capsule of the liver (implant) versus (b) lesion situated within the hepatic parenchyma

Fig. 2

Kaplan–Meier curve depicting overall and recurrence-free survival of patients who underwent curative-intent surgery for gynecologic liver metastasis

Fig. 3

Kaplan–Meier curve comparing overall survival of patients who underwent curative-intent surgery for gynecologic liver metastasis with survival of patients who underwent liver biopsy only

Fig. 4

Kaplan–Meier curve showing overall survival stratified by location of liver metastasis, capsular/implant versus deeply situated/ parenchymal