Liver Resection for Non-colorectal Non-neuroendocrine Metastases: Where Do We Stand Today Compared to Colorectal Cancer?
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The continuing controversy about surgery for non-colorectal non-neuroendocrine liver metastases (NCRNNE) necessitates identifying risk factors of worsened outcomes to improve patient selection and survival. Prospectively collected data of 167 patients undergoing hepatectomy for NCRNNE were analyzed, and a comparison to a matched population of colorectal liver metastases (CLM) was performed. Overall survival (OS) (35 vs. 54 months; P = 0.008) and recurrence-free survival (RFS) (15 vs. 29 months; P = 0.004) of NCRNNE patients were significantly shorter compared to those with CLM. The best survival was found in the genitourinary (GU; OS, 45 months; RFS, 21 months) NCRNNE subgroup, whereas survival for gastrointestinal (GI) metastases was low (OS, 8 months; RFS, 7 months). Patients with renal cell carcinoma (RCC) showed excellent outcomes when compared to CLM (OS, 50 vs. 51 months; P = 0.901). Extrahepatic disease (EHD) was identified as independent prognostic factor for reducing both RFS (P = 0.040) and OS (P = 0.046). The number of liver lesions (P = 0.024), residual tumor (P = 0.025), and major complications (P = 0.048) independently diminished OS. The degree of survival advantage by surgery is determined by the primary tumor site, EHD, the number of metastases, and residual tumor. Thus—even more than in CLM—these oncological selection criteria must prevail. GU metastases, especially RCC, represent a favorable subgroup.
KeywordsLiver resection Metastasis Non-colorectal Non-neuroendocrine Renal cell carcinoma
The authors thank Stephanie Schreiber, Dr. Carsta Stielow, and Dr. Hans-Martin Hornung for their dedicated work with the patients’ data collection and IT administration of the liver database.
Compliance with Ethical Standards
The study was approved by the ethics committee, Faculty of Medicine, Ludwig-Maximilians-University (LMU), Munich, Germany.
Conflict of Interest
The authors declare that they have no conflicts of interest.
No funding was received for the present study.
This article is not based on a previous communication to a society or meeting.
- 14.Munich Cancer Registry, Munich Tumor Center, 2016. http://www.tumorregister-muenchen.de/en/facts/specific_analysis.php
- 23.Elias D, Cavalcanti de AA, Eggenspieler P, Plaud B, Ducreux M, Spielmann M, Theodore C, Bonvalot S, Lasser P. Resection of liver metastases from a noncolorectal primary: indications and results based on 147 monocentric patients. J Am Coll Surg 1998;187:487–493.Google Scholar
- 38.Slotta JE, Schuld J, Distler S, Richter S, Schilling MK, Kollmar O. Hepatic resection of non-colorectal and non-neuroendocrine liver metastases—survival benefit for patients with non-gastrointestinal primary cancers—a case-controlled study. Int J Surg 2014;12:163–168.Google Scholar
- 39.Groeschl RT, Nachmany I, Steel JL, Reddy SK, Glazer ES, de Jong MC, Pawlik TM, Geller DA, Tsung A, Marsh JW, Clary BM, Curley SA, Gamblin TC. Hepatectomy for noncolorectal non-neuroendocrine metastatic cancer: a multi-institutional analysis. J Am Coll Surg 2012;214:769–777.CrossRefPubMedGoogle Scholar
- 40.Adam R, Chiche L, Aloia T, Elias D, Salmon R, Rivoire M, Jaeck D, Saric J, Le Treut YP, Belghiti J, Mantion G, Mentha G. Hepatic resection for noncolorectal nonendocrine liver metastases: analysis of 1,452 patients and development of a prognostic model. Ann Surg 2006;244:524–535.CrossRefPubMedPubMedCentralGoogle Scholar
- 43.Takemura N, Saiura A, Koga R, Arita J, Yoshioka R, Ono Y, Hiki N, Sano T, Yamamoto J, Kokudo N, Yamaguchi T. Long-term outcomes after surgical resection for gastric cancer liver metastasis: an analysis of 64 macroscopically complete resections. Langenbecks Arch Surg 2012;397:951–957.CrossRefPubMedGoogle Scholar