Georgios A Margonis1, Stefan Buettner1, Kazunari Sasaki1, Yuhree Kim1, Francesca Ratti2, Nadia Russolillo3, Alessandro Ferrero3, Nickolas Berger4, T Clark Gamblin4, George Poultsides5, Thuy Tran5, Lauren M Postlewait6, Shishir Maithel6, Alex D Michaels7, Todd W Bauer7, Hugo Marques8, Eduardo Barroso8, Luca Aldrighetti2, Timothy M Pawlik9. 1. Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. 2. Liver Unit, Department of Hepatobiliary Surgery, San Raffaele Hospital, Milan, Italy. 3. Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I", Turin, Italy. 4. Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA. 5. Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA. 6. Department of Surgery, Emory University, Atlanta, GA, USA. 7. Department of Surgery, University of Virginia, Charlottesville, VA, USA. 8. Hepato-biliary-pancreatic and Transplantation Center, Curry Cabral Hospital, Lisbon, Portugal. 9. Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: tpawlik1@jhmi.edu.
Abstract
BACKGROUND: Data on surgical management of breast liver metastasis are limited. We sought to determine the safety and long-term outcome of patients undergoing hepatic resection of breast cancer liver metastases (BCLM). METHODS: Using a multi-institutional, international database, 131 patients who underwent surgery for BCLM between 1980 and 2014 were identified. Clinicopathologic and outcome data were collected and analyzed. RESULTS: Median tumor size of the primary breast cancer was 2.5 cm (IQR: 2.0-3.2); 58 (59.8%) patients had primary tumor nodal metastasis. The median time from diagnosis of breast cancer to metastasectomy was 34 months (IQR: 16.8-61.3). The mean size of the largest liver lesion was 3.0 cm (2.0-5.0); half of patients (52.0%) had a solitary metastasis. An R0 resection was achieved in most cases (90.8%). Postoperative morbidity and mortality were 22.8% and 0%, respectively. Median and 3-year overall-survival was 53.4 months and 75.2%, respectively. On multivariable analysis, positive surgical margin (HR 3.57, 95% CI 1.40-9.16; p = 0.008) and diameter of the BCLM (HR 1.03, 95% CI 1.01-1.06; p = 0.002) remained associated with worse OS. DISCUSSION: In selected patients, resection of breast cancer liver metastases can be done safely and a subset of patients may derive a relatively long survival, especially from a margin negative resection.
BACKGROUND: Data on surgical management of breast liver metastasis are limited. We sought to determine the safety and long-term outcome of patients undergoing hepatic resection of breast cancer liver metastases (BCLM). METHODS: Using a multi-institutional, international database, 131 patients who underwent surgery for BCLM between 1980 and 2014 were identified. Clinicopathologic and outcome data were collected and analyzed. RESULTS: Median tumor size of the primary breast cancer was 2.5 cm (IQR: 2.0-3.2); 58 (59.8%) patients had primary tumor nodal metastasis. The median time from diagnosis of breast cancer to metastasectomy was 34 months (IQR: 16.8-61.3). The mean size of the largest liver lesion was 3.0 cm (2.0-5.0); half of patients (52.0%) had a solitary metastasis. An R0 resection was achieved in most cases (90.8%). Postoperative morbidity and mortality were 22.8% and 0%, respectively. Median and 3-year overall-survival was 53.4 months and 75.2%, respectively. On multivariable analysis, positive surgical margin (HR 3.57, 95% CI 1.40-9.16; p = 0.008) and diameter of the BCLM (HR 1.03, 95% CI 1.01-1.06; p = 0.002) remained associated with worse OS. DISCUSSION: In selected patients, resection of breast cancer liver metastases can be done safely and a subset of patients may derive a relatively long survival, especially from a margin negative resection.
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