Is there a role for surgical resections of hepatic breast cancer metastases?

Breast cancer accounts for over 12,000 deaths in the UK annually; 12% of women develop hepatic metastases receiving systemic therapy as standard treatment. Hepatic resection has been proposed as a potentially curative alternative. Current literature was reviewed and evaluated for hepatic resection on breast cancer liver metastases by conducting a literature search across Ovid Medline, Embase and PubMed. Twenty-one studies were included in the review. All were retrospective, single centre case series. Eighteen studies reported results for ten or more patients. Only three studies reported results for over 50 patients. The time-span for the individual series ranged from 9-20 years. Generally, liver resection for breast cancer liver metastases is a safe procedure with only two post-operative deaths reported. Median time to recurrence was low (10-36 months). Overall 5-year survival ranged from 12-75%. Poorer prognosis correlated with increasing size and number of metastases, extrahepatic spread and short time span from primary surgery to the development of further metastases. Current literature does not establish clearly, who should undergo a hepatic resection for breast cancer metastasis. But it seems that hepatic resection should be considered as a therapeutic option for limited volume liver metastasis in high-risk breast cancer patients. However, prospective cohort studies are required to establish the role of hepatic resection for breast cancer metastasis.