Abstract
Background
Except for patients with gastrointestinal stromal tumors (GIST), systemic chemotherapy in patients with liver metastasis of soft-tissue sarcoma (STS) is not effective. Therefore, all patients with resectable liver metastases underwent surgical therapy. We present our experience with this approach during the last 13 years.
Methods
All patients (n = 45) with liver metastasis of STS undergoing surgical therapy were prospectively analyzed. Clinical and histopathological parameters as well as the postoperative course were recorded. Survival data were analyzed by using the Kaplan-Meier method and the log-rank test.
Results
Twenty-seven of 45 patients with liver metastasis underwent hepatic resection; 59% of these patients had a solitary metastasis, 22% had two metastases, and 18% had three or more metastatic nodules. The surgical perioperative mortality was 7%. The median survival was 44 (range, 1–123) months, and the 5-year survival was 49%. Repeated resection for recurrent tumor was performed in eight patients, which yielded a median survival of 76 months.
Conclusions
Patients who have hepatic metastases that are functionally and technically resectable should be considered for surgery because this treatment offers the chance for long-term survival (>5 years).
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References
Pisters PW, Leung DH, Woodruff J et al (1996) Analysis of prognostic factors in 1, 041 patients with localized soft tissue sarcomas of the extremities. J Clin Oncol 14:1679–1689
Le Cesne A, Judson I, Crowther D et al (2000) Randomized phase III study comparing conventional-dose doxorubicin plus ifosphamid versus high dose doxorubicin plus ifosphamid plus recombinant granulocyte-macrophage colony-stimulating factor in advanced soft tissue sarcoma: A trial of the European Organisation for Research and Treatment of Cancer/Soft Tissue and Bone Sarcoma Group. J Clin Oncol 18:2676–2684
Simmonds PC, Primrose JN, Colquitt JL et al (2006) Surgical resection of hepatic metastases from colorectal cancer: a systematic review of published studies. Br J Cancer 94:982–999
Lang H, Nußbaum KT, Kaudel P et al (2000) Hepatic metastases from leiomyosarcoma. Ann Surg 231:500–505
DeMatteo RP, Shah A, Fong Y et al (2001) Results of hepatic resection for sarcoma metastatic to liver. Ann Surg 234:540–548
Shima Y, Horimi T, Ishikawa T et al (2003) Aggressive surgery for liver metastases from gastrointestinal stromal tumors. J Hepatobiliary Pancreat Surg 10:77–80
Mudan SS, Conlon KC, Woodruff JM et al (2000) Salvage surgery for patients with recurrent gastrointestinal sarcoma: prognostic factors to guide patient selection. Cancer 88:66–74
Jaques DP, Coit DG, Casper ES et al (1995) Hepatic metastases from soft-tissue sarcoma. Ann Surg 221:392–397
Merimsky O, Terrier P, Stanca A et al (1999) Liver metastases from extremity soft tissue sarcoma. Am J Clin Oncol 22:70–72
Nunobe S, Sano T, Shimada K et al (2005) Surgery including liver resection for metastatic gastrointestinal stromal tumors or gastrointestinal leiomyosarcomas. Jpn J Clin Oncol 35:338–341
Berber E, Ari E, Herceg N et al (2005) Laparoscopic radiofrequency thermal ablation for unusual hepatic tumors: operative indications and outcomes. Surg Endosc 19:1613–1617
Mulier S, Ni Y, Jamart J et al (2005) Local recurrence after hepatic radiofrequency coagulation. Ann Surg 242:158–171
Urata K, Kawasaki S, Matsumanni H et al (1995) Calculation of child and adult standard liver volume for liver transplantation. Hepatology 21:1317–1321
De Baere T, Roche A, Elias D et al (1996) Preoperative portal vein embolization for extension of hepatectomy indications. Hepatology 24:1386–1391
Coindre JM, Terrier P, Guillou L et al (2001) Predictive value of grade for metastasis development in the main histologic types of adult soft tissue sarcoma: a study of 1240 patients from the French Federation of Cancer Centers Sarcoma Group. Cancer 91:1914–1926
Kaplan EL, Meier P (1958) Nonparametric estimation from incomplete observations. J Am Statist Assoc 53:457–481
Weitz J, Antonescu CR, Brennan MF (2003) Localized extremity soft tissue sarcoma: Improved knowledge with unchanged survival over time. J Clin Oncol 21:2719–2725
Engellaus J, Anderson H, Rydholm A et al (2004) Time dependence of prognostic factors for patients with soft tissue sarcoma: a Scandinavian Sarcoma Group study of 338 malignant fibrous histiocytomas. Cancer 100:2233–2239
Billingsley KG, Lewis JJ, Leung DH et al (1999) Multifactorial analysis of the survival of patients with distant metastasis arising from primary extremity sarcoma. Cancer 85:389–395
Behranwala KA, Roy P, Giblin V et al (2004) Intra-abdominal metastases from soft tissue sarcoma. J Surg Oncol 87:116–120
Rydholm A, Gustafson P, Alvegard TA et al (1999) Prognostic factors in soft tissue sarcoma: a review and the Scandinavian Sarcoma Group experience. Acta Orthop Scand Suppl 285:50–57
Stojadinovic KG, Lewis JJ, Leung DH et al (2002) Primary adult soft tissue sarcoma: time-dependent influence of prognostic variables. J Clin Oncol 20:4344–4352
Bramwell VHC (2003) Doxorubicin-based chemotherapy for the palliative treatment of adult patients with locally advanced or metastatic soft tissue sarcoma. Cochrane Database Syst Rev 2003;CD003293. Review
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Supported by the Günther-Haenisch Forschungs- und Studienstiftung der Vereinigung Nordwestdeutscher Chirurgen (MP).
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Rehders, A., Peiper, M., Stoecklein, N.H. et al. Hepatic Metastasectomy for Soft-Tissue Sarcomas: Is It Justified?. World J Surg 33, 111–117 (2009). https://doi.org/10.1007/s00268-008-9777-4
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DOI: https://doi.org/10.1007/s00268-008-9777-4