Surgery for liver metastases originating from sarcoma—case series

  • Maximilian ZacherlEmail author
  • Gerwin A. Bernhardt
  • Johannes Zacherl
  • Gerald Gruber
  • Peter Kornprat
  • Heinz Bacher
  • Hans-Jörg Mischinger
  • Reinhard Windhager
  • Raimund Jakesz
  • Thomas Grünberger
Original Article



Liver metastases originating from various types of sarcoma are a rare reason for hepatic resection. So far, even multicentre studies do hardly provide statistically relevant sample sizes. Thus, review of available data can provide surgeons with useful information in similar cases. Therefore, this study can be regarded more as a contribution to this pool of data than as a stand-alone paper.

Patients and methods

The study includes 10 women and five men who underwent subtotal hepatic resection for solitary (n = 4) and multiple (n = 11) liver metastases originating from sarcoma. The median tumour diameter was 60 mm (range 20–200 mm).


Morbidity was 33%. One patient died within 30 days after surgery. Resection was complete (R0) in 67%. Median overall survival was 33.6 months, 5-year survival 27%. The use of Pringle manoeuvre was significantly associated with poorer outcome (p = 0.014) and shorter period of recurrence-free survival (p = 0.012). Diameter of liver lesion over 50 mm showed significantly shorter recurrence-free survival (p = 0.042).


Hepatic resection may be beneficial in patients with isolated sarcoma metastasis in the liver.


Liver Metastasis Sarcoma Hepatectomy 



The authors thank Rene Adam, M.D. and Javier C Lendoire, M.D. for their review of Table 3 and Eugenia Lamont for proofreading the manuscript.

Conflicts of interest



  1. 1.
    Van Glabbeke M, van Oosterom AT, Oosterhuis JW et al (1999) Prognostic factors for the outcome of chemotherapy in advanced soft tissue sarcoma: an analysis of 2,185 patients treated with anthracycline-containing first-line regimens—a European Organization for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group Study. J Clin Oncol 17(1):150–157PubMedGoogle Scholar
  2. 2.
    Billingsley KG, Burt ME, Jara E et al (1999) Pulmonary metastases from soft tissue sarcoma: analysis of patterns of diseases and postmetastasis survival. Ann Surg 229(5):602–610, discussion 610–612PubMedCrossRefGoogle Scholar
  3. 3.
    Smith R, Pak Y, Kraybill W, Kane JM 3rd (2009) Factors associated with actual long-term survival following soft tissue sarcoma pulmonary metastasectomy. Eur J Surg Oncol 35(4):356–361PubMedGoogle Scholar
  4. 4.
    Jain A, Sajeevan KV, Babu KG, Lakshmaiah KC (2009) Chemotherapy in adult soft tissue sarcoma. Indian J Cancer 46(4):274–287PubMedCrossRefGoogle Scholar
  5. 5.
    Chen H, Pruitt A, Nicol TL et al (1998) Complete hepatic resection of metastases from leiomyosarcoma prolongs survival. J Gastrointest Surg 2(2):151–155PubMedCrossRefGoogle Scholar
  6. 6.
    Elias D, Cavalcantide de Albuquerque A, Eggenspieler P et al (1998) Resection of liver metastases from a noncolorectal primary: indications and results based on 147 monocentric patients. J Am Coll Surg 187(5):487–493PubMedCrossRefGoogle Scholar
  7. 7.
    Hemming AW, Sielaff TD, Gallinger S et al (2000) Hepatic resection of noncolorectal nonneuroendocrine metastases. Liver Transpl 6(1):97–101PubMedGoogle Scholar
  8. 8.
    Jaques DP, Coit DG, Casper ES, Brennan MF (1995) Hepatic metastases from soft-tissue sarcoma. Ann Surg 221(4):392–397PubMedCrossRefGoogle Scholar
  9. 9.
    Lang H, Nussbaum KT, Kaudel P et al (2000) Hepatic metastases from leiomyosarcoma: a single-center experience with 34 liver resections during a 15-year period. Ann Surg 231(4):500–505PubMedCrossRefGoogle Scholar
  10. 10.
    Morrow CE, Grage TB, Sutherland DE, Najarian JS (1982) Hepatic resection for secondary neoplasms. Surgery 92(4):610–614PubMedGoogle Scholar
  11. 11.
    O’Rourke TR, Tekkis P, Yeung S et al (2008) Long-term results of liver resection for non-colorectal, non-neuroendocrine metastases. Ann Surg Oncol 15(1):207–218PubMedCrossRefGoogle Scholar
  12. 12.
    Zacherl M, Langle F, Steininger R et al (2001) Surgery for non-colorectal and non-neuroendocrine liver metastases. Wien Klin Wochenschr 113(17–18):681–687PubMedGoogle Scholar
  13. 13.
    Zacherl J, Zacherl M, Scheuba C et al (2002) Analysis of hepatic resection of metastasis originating from gastric adenocarcinoma. J Gastrointest Surg 6(5):682–689PubMedCrossRefGoogle Scholar
  14. 14.
    DeMatteo RP, Shah A, Fong Y et al (2001) Results of hepatic resection for sarcoma metastatic to liver. Ann Surg 234(4):540–547, discussion 547–548PubMedCrossRefGoogle Scholar
  15. 15.
    Adam R, Chiche L, Aloia T et al (2006) Hepatic resection for noncolorectal nonendocrine liver metastases: analysis of 1,452 patients and development of a prognostic model. Ann Surg 244(4):524–535PubMedGoogle Scholar
  16. 16.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213PubMedCrossRefGoogle Scholar
  17. 17.
    Pringle JHV (1908) Notes on the arrest of hepatic hemorrhage due to trauma. Ann Surg 48(4):541–549PubMedCrossRefGoogle Scholar
  18. 18.
    Pawlik TM, Vauthey JN, Abdalla EK et al (2006) Results of a single-center experience with resection and ablation for sarcoma metastatic to the liver. Arch Surg 14(6):537–543, discussion 543–544Google Scholar
  19. 19.
    Zalinski S, Palavecino M, Abdalla EK (2009) Hepatic resection for gastrointestinal stromal tumor liver metastases. Hematol Oncol Clin North Am 23(1):115–127, ixPubMedCrossRefGoogle Scholar
  20. 20.
    Yap BS, Baker LH, Sinkovics JG et al (1980) Cyclophosphamide, vincristine, adriamycin, and DTIC (CYVADIC) combination chemotherapy for the treatment of advanced sarcomas. Cancer Treat Rep 64(1):93–98PubMedGoogle Scholar
  21. 21.
    Ng EH, Pollock RE, Romsdahl MM (1992) Prognostic implications of patterns of failure for gastrointestinal leiomyosarcomas. Cancer 69(6):1334–1341PubMedCrossRefGoogle Scholar
  22. 22.
    Verazin GT, Warneke JA, Driscoll DL et al (1992) Resection of lung metastases from soft-tissue sarcomas. A multivariate analysis. Arch Surg 127(12):1407–1411PubMedGoogle Scholar
  23. 23.
    Ercolani G, Grazi GL, Ravaioli M et al (2005) The role of liver resections for noncolorectal, nonneuroendocrine metastases: experience with 142 observed cases. Ann Surg Oncol 12(6):459–466PubMedCrossRefGoogle Scholar
  24. 24.
    Reddy SK, Barbas AS, Marroquin CE et al (2007) Resection of noncolorectal nonneuroendocrine liver metastases: a comparative analysis. J Am Coll Surg 204(3):372–382PubMedCrossRefGoogle Scholar
  25. 25.
    Rehders A, Peiper M, Stoecklein NH et al (2009) Hepatic metastasectomy for soft-tissue sarcomas: is it justified? World J Surg 33(1):111–117PubMedCrossRefGoogle Scholar
  26. 26.
    Mavligit GM, Zukwiski AA, Ellis LM et al (1995) Gastrointestinal leiomyosarcoma metastatic to the liver. Durable tumor regression by hepatic chemoembolization infusion with cisplatin and vinblastine. Cancer 75(8):2083–2088PubMedCrossRefGoogle Scholar
  27. 27.
    Demetri GD, von Mehren M, Blanke CD et al (2002) Efficacy and safety of imatinib mesylate in advanced gastrointestinal stromal tumors. N Engl J Med 347(7):472–480PubMedCrossRefGoogle Scholar
  28. 28.
    DeMatteo RP, Ballman KV, Antonescu CR et al (2009) Adjuvant imatinib mesylate after resection of localised, primary gastrointestinal stromal tumour: a randomised, double-blind, placebo-controlled trial. Lancet 373(9669):1097–1104PubMedCrossRefGoogle Scholar
  29. 29.
    DeMatteo RP, Maki RG, Singer S et al (2007) Results of tyrosine kinase inhibitor therapy followed by surgical resection for metastatic gastrointestinal stromal tumor. Ann Surg 245(3):347–352PubMedCrossRefGoogle Scholar
  30. 30.
    Bernhard GA, Bacher H, Hagen D et al (2004) Heat shock protein 70: a new biomarker for ischemic–reperfusion injury due to Pringle maneuver. Eur Surg 36(5):305–310CrossRefGoogle Scholar
  31. 31.
    El-Badry AM, Breitenstein S, Jochum W et al (2009) Assessment of hepatic steatosis by expert pathologists: the end of a gold standard. Ann Surg 250(5):691–697PubMedCrossRefGoogle Scholar
  32. 32.
    Earle SA, Perez EA, Gutierrez JC et al (2006) Hepatectomy enables prolonged survival in select patients with isolated noncolorectal liver metastasis. J Am Coll Surg 203(4):436–446PubMedCrossRefGoogle Scholar
  33. 33.
    Goering JD, Mahvi DM, Niederhuber JE et al (2002) Cryoablation and liver resection for noncolorectal liver metastases. Am J Surg 183(4):384–389PubMedCrossRefGoogle Scholar
  34. 34.
    Harrison LE, Brennan MF, Newman E et al (1997) Hepatic resection for noncolorectal, nonneuroendocrine metastases: a fifteen-year experience with ninety-six patients. Surgery 121(6):625–632PubMedCrossRefGoogle Scholar
  35. 35.
    Lendoire J, Moro M, Andriani O et al (2007) Liver resection for non-colorectal, non-neuroendocrine metastases: analysis of a multicenter study from Argentina. HPB (Oxford) 9(6):435–439Google Scholar
  36. 36.
    van Ruth S, Mutsaerts E, Zoetmulder FA, van Coevorden F (2001) Metastasectomy for liver metastases of non-colorectal primaries. Eur J Surg Oncol 27(7):662–667PubMedGoogle Scholar
  37. 37.
    Yedibela S, Gohl J, Graz V et al (2005) Changes in indication and results after resection of hepatic metastases from noncolorectal primary tumors: a single-institutional review. Ann Surg Oncol 12(10):778–785PubMedCrossRefGoogle Scholar
  38. 38.
    Foster JH (1978) Survival after liver resection for secondary tumors. Am J Surg 135(3):389–394PubMedCrossRefGoogle Scholar
  39. 39.
    Teo MC, Tan YM, Chung AY et al (2006) Metastectomy for non-colorectal, non-neuroendocrine liver secondaries. ANZ J Surg 76(7):575–578PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Maximilian Zacherl
    • 2
    Email author
  • Gerwin A. Bernhardt
    • 3
  • Johannes Zacherl
    • 1
  • Gerald Gruber
    • 2
  • Peter Kornprat
    • 3
  • Heinz Bacher
    • 3
  • Hans-Jörg Mischinger
    • 3
  • Reinhard Windhager
    • 4
  • Raimund Jakesz
    • 1
  • Thomas Grünberger
    • 1
  1. 1.Division of General Surgery, Department of SurgeryMedical University of ViennaViennaAustria
  2. 2.Department of OrthopedicsMedical University of GrazGrazAustria
  3. 3.Division of General Surgery, Department of SurgeryMedical University of GrazGrazAustria
  4. 4.Department of OrthopedicsMedical University of ViennaViennaAustria

Personalised recommendations