Liver Metastases of Other than Colorectal Origin
Authors:
V. Třeška; V. Liška; T. Skalický; A. Sutnar; D. Šmíd; A. Ňaršanská; M. Vachtová; Inka Třešková
; J. Brůha; O. Vyčítal
Authors place of work:
Chirurgická klinika FN a LF UK v Plzni, přednosta: prof. MUDr. Vladislav Třeška, DrSc.
Published in the journal:
Rozhl. Chir., 2010, roč. 89, č. 3, s. 202-207.
Category:
Monothematic special - Original
Summary
Aim:
Colorectal carcinoma is the commonest malignancy with liver metastases. Approximately 25–30% of these metastases are resectable with good long-term outcomes. Liver metastases of so called non-colorectal carcinomas are significantly less common, and considering different biological character of these metastases, compared to colorectal ones, surgical management of some of these types is debatable, however, in some cases remains highly successful. The aim of this study was to assess the authors’ outcomes of surgical and termoablation therapy of non-colorectal liver metastases.
Methods:
The authors present their experience with surgical treatment in 68 patients – mean age of 58.2 y.o.a (33.1–77.5) with liver metastases of non-colorectal carcinomas– NKJM (the commonest types: breast carcinoma – 32.4%, carcinoid – 20.6%, renal carcinoma – 13.3%, gynecological tumors – 13.3%, gastrointestinal stromal tumor – 4.4%, gastric carcinoma – 4.4% ) during 2001–2008. The mean time after primary surgery for carcinoma was 3.9 years (0–8.5 let). The surgical procedures included the following: radiofrequency ablation (RFA) – 50 patients (73.5%), resections in 26.5%. Preoperative chemotherapeutical „downstaging“ or portal vein embolization on the tumor side, in order to improve the NKJM resecability, was performed in 10 subjects (14.7%). Resecable or RFA – manageable extrahepatic metastases were removed using one- or more- step procedures in 25 subjects (36.7%). The total number of liver metastases within the whole study group ranged from 1 (28x) to 8 (1x) metastases. Postoperative adjuvant chemotherapy, combined with biological treatment in some patients, was administered to a total of 33 patients (48.5%).
Results:
One year after the procedure and RFA, a total of 88.6% of patients were surviving, at 3 years 72.5 % and at 5 years 36.9% of the subjects. Considering four commonest tumors (breast carcinoma, carcinoid, gynecological carcinomas and renal carcinoma), the best 5-year survival rates were recorded in patients with carcinoid metastases (100%), 33.8% of patients with breast metastases were surviving at 5 years, 44.4% of patients with renal carcinoma metastases were surviving at 3 years and 72.9% of patients with gynecological tumors were surviving at 2 years. There were no statistically significant differences in long-term survival rates between RFA and resections. Patients with extrahepatic metastases had worse prognosis (p < 0.01).
Conclusion:
Liver resection and RFA have their definite place in multimodal treatment strategy in the management of non- colorectal carcinoma liver metastases (NKJM). Indication for surgery must be made on strictly individual basis, in particular in patients with NKJM, in order to achieve quality long-term survival in these patients.
Key words:
non-colorectal carcinoma liver metastases – radiofrequency ablation – resection – long-term outcomes
Zdroje
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