Abstract
Background
The management of patients with liver metastasis from a gynecologic carcinoma remains controversial, as there is currently little data available. We sought to determine the safety and efficacy of liver-directed surgery for hepatic metastasis from gynecologic primaries.
Methods
Between 1990 and 2010, 87 patients with biopsy-proven liver metastasis from a gynecologic carcinoma were identified from an institutional hepatobiliary database. Fifty-two (60%) patients who underwent hepatic surgery for their liver disease and 35 (40%) patients who underwent biopsy only were matched for age, primary tumor characteristics, and hepatic tumor burden. Clinicopathologic, operative, and outcome data were collected and analyzed.
Results
Of the 87 patients, 30 (34%) presented with synchronous metastasis. The majority of patients had multiple hepatic tumors (63%), with a median size of the largest lesion being 2.5 cm. Of those patients who underwent liver surgery (n = 52), most underwent a minor hepatic resection (n = 44; 85%), while 29 (56%) patients underwent concurrent lymphadenectomy and 45 (87%) patients underwent simultaneous peritoneal debulking. Postoperative morbidity and mortality were 37% and 0%, respectively. Median survival from time of diagnosis was 53 months for patients who underwent liver-directed surgery compared with 21 months for patients who underwent biopsy alone (n = 35) (p = 0.01). Among those patients who underwent liver-directed surgery, 5-year survival following hepatic resection was 41%.
Conclusions
Hepatic surgery for liver metastasis from gynecologic cancer can be performed safely. Liver surgery may be associated with prolonged survival in a subset of patients with hepatic metastasis from gynecologic primaries and therefore should be considered in carefully selected patients.
Similar content being viewed by others
References
Jemal A, Siegel R, Xu J, Ward E (2010) Cancer statistics, 2010. CA Cancer J Clin 60(5):277–300
Dauplat J, Hacker NF, Nieberg RK et al (1987) Distant metastases in epithelial ovarian carcinoma. Cancer 60(7):1561–1566
Bonnefoi H, A’Hern RP, Fisher C et al (1999) Natural history of stage IV epithelial ovarian cancer. J Clin Oncol 17(3):767–775
Cormio G, Rossi C, Cazzolla A et al (2003) Distant metastases in ovarian carcinoma. Int J Gynecol Cancer 13(2):125-129
Rose PG, Piver MS, Tsukada Y, Lau TS (1989) Metastatic patterns in histologic variants of ovarian cancer. An autopsy study. Cancer 64(7):1508–1513
Kerr VE, Cadman E (1985) Pulmonary metastases in ovarian cancer. Analysis of 357 patients. Cancer 56(5):1209–1213
Tangjitgamol S, Levenback CF, Beller U, Kavanagh JJ (2004) Role of surgical resection for lung, liver, and central nervous system metastases in patients with gynecological cancer: a literature review. Int J Gynecol Cancer 14(3):399–422
Guth U, Huang DJ, Bauer G et al (2007) Metastatic patterns at autopsy in patients with ovarian carcinoma. Cancer 110(6):1272–1280
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):524–535
Ercolani G, Vetrone G, Grazi GL et al (2009) The role of liver surgery in the treatment of non-colorectal non-neuroendocrine metastases (NCRNNE). Analysis of 134 resected patients. Minerva Chir 64(6):551–558
Choi EA, Abdalla EK (2007) Patient selection and outcome of hepatectomy for noncolorectal non-neuroendocrine liver metastases. Surg Oncol Clin N Am 16(3):557–577 ix
Reddy SK, Barbas AS, Marroquin CE et al (2007) Resection of noncolorectal nonneuroendocrine liver metastases: a comparative analysis. J Am Coll Surg 204(3):372–382
Chalkiadakis GE, Lasithiotakis KG, Petrakis I et al (2005) Major hepatectomy and right hemicolectomy at the time of primary cytoreductive surgery for advanced ovarian cancer: report of a case. Int J Gynecol Cancer 15(6):1115–1119
Nair A, Pai DR (2005) Single cystic liver metastasis in residual carcinoma of the uterine cervix. Eur J Obstet Gynecol Reprod Biol 122(1):126–127
Bojalian MO, Machado GR, Swensen R, Reeves ME (2004) Radiofrequency ablation of liver metastasis from ovarian adenocarcinoma: case report and literature review. Gynecol Oncol 93(2):557–560
Chi DS, Temkin SM, Abu-Rustum NR et al (2002) Major hepatectomy at interval debulking for stage IV ovarian carcinoma: a case report. Gynecol Oncol 87(1):138–142
Garduno-Lopez AL, Mondragon-Sanchez R, Herrera-Goepfert R, Bernal-Maldonado R (2002) Resection of liver metastases from a virilizing steroid (lipoid) cell ovarian tumor. Hepatogastroenterology 49(45):657–659
Bristow RE, Montz FJ, Lagasse LD et al (1999) Survival impact of surgical cytoreduction in stage IV epithelial ovarian cancer. Gynecol Oncol 72(3):278–287
Merideth MA, Cliby WA, Keeney GL et al (2003) Hepatic resection for metachronous metastases from ovarian carcinoma. Gynecol Oncol 89(1):16–21
Chi DS, Fong Y, Venkatraman ES, Barakat RR (1997) Hepatic resection for metastatic gynecologic carcinomas. Gynecol Oncol 66(1):45–51
Lee JH, Kim KS, Chung CW et al (2002) Hepatic resection of metastatic tumor from serous cystadenocarcinoma of the ovary. J Korean Med Sci 17(3):415–418
Kaseki H, Yasui K, Niwa K et al (1992) Hepatic resection for metastatic squamous cell carcinoma from the uterine cervix. Gynecol Oncol 44(3):284–287
La Fianza A, Alberici E, Biasina AM et al (1999) Spontaneous hemorrhage of a liver metastasis from squamous cell cervical carcinoma: case report and review of the literature. Tumori 85(4):290–293
Savage AP, Malt RA (1992) Survival after hepatic resection for malignant tumours. Br J Surg 79(10):1095–1101
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):625–632
Lim MC, Kang S, Lee KS et al (2009) The clinical significance of hepatic parenchymal metastasis in patients with primary epithelial ovarian cancer. Gynecol Oncol 112(1):28–34
Yoon SS, Jarnagin WR, Fong Y et al (2003) Resection of recurrent ovarian or fallopian tube carcinoma involving the liver. Gynecol Oncol 91(2):383–388
Onda T, Yoshikawa H, Yasugi T et al (2005) Secondary cytoreductive surgery for recurrent epithelial ovarian carcinoma: proposal for patients selection. Br J Cancer 92(6):1026–1032
Kosary CL (1994) FIGO stage, histology, histologic grade, age and race as prognostic factors in determining survival for cancers of the female gynecological system: an analysis of 1973–87 SEER cases of cancers of the endometrium, cervix, ovary, vulva, and vagina. Semin Surg Oncol 10(1):31–46
Makhija S, Howden N, Edwards R et al (2002) Positron emission tomography/computed tomography imaging for the detection of recurrent ovarian and fallopian tube carcinoma: a retrospective review. Gynecol Oncol 85(1):53–58
Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196
Silber JH, Rosenbaum PR, Polsky D et al (2007) Does ovarian cancer treatment and survival differ by the specialty providing chemotherapy? J Clin Oncol 25(10):1169–1175
Zheng QQ, Wang P, Hui R, Yao AM (2009) Prognostic analysis of ovarian cancer patients using the Cox regression model. Ai Zheng 28(2):170–172
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 141(6):537–543 discussion 543-544
Pawlik TM, Gleisner AL, Bauer TW et al (2007) Liver-directed surgery for metastatic squamous cell carcinoma to the liver: results of a multi-center analysis. Ann Surg Oncol 14(10):2807–2816
de Jong MC, Tsai S, Cameron JL et al (2010) Safety and efficacy of curative intent surgery for peri-ampullary liver metastasis. J Surg Oncol 102(3):256–263
Eisenkop SM, Friedman RL, Spirtos NM (2000) The role of secondary cytoreductive surgery in the treatment of patients with recurrent epithelial ovarian carcinoma. Cancer 88(1):144–153
Goodman HM, Harlow BL, Sheets EE et al (1992) The role of cytoreductive surgery in the management of stage IV epithelial ovarian carcinoma. Gynecol Oncol 46(3):367–371
Zang RY, Zhang ZY, Cai SM et al (1999) Cytoreductive surgery for stage IV epithelial ovarian cancer. J Exp Clin Cancer Res 18(4):449–454
Griffiths CT (1975) Surgical resection of tumor bulk in the primary treatment of ovarian carcinoma. Natl Cancer Inst Monogr 42:101–104
Hacker NF, Berek JS, Lagasse LD et al (1983) Primary cytoreductive surgery for epithelial ovarian cancer. Obstet Gynecol 61(4):413–420
Hoskins WJ, Bundy BN, Thigpen JT, Omura GA (1992) The influence of cytoreductive surgery on recurrence-free interval and survival in small-volume stage III epithelial ovarian cancer: a Gynecologic Oncology Group study. Gynecol Oncol 47(2):159–166
Delgado G, Oram DH, Petrilli ES (1984) Stage III epithelial ovarian cancer: the role of maximal surgical reduction. Gynecol Oncol 18(3):293–298
Del Campo JM, Felip E, Rubio D et al (1994) Long-term survival in advanced ovarian cancer after cytoreduction and chemotherapy treatment. Gynecol Oncol 53(1):27–32
Chua TC, Robertson G, Liauw W, Morris DL (2010) Salvage cytoreduction for chemorefractory ovarian cancer with peritoneal carcinomatosis: a last chance or futile efforts? Aust N Z J Obstet Gynaecol 50(5):478–484
Vergote I, Trope CG, Amant F et al (2010) Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. N Engl J Med 363(10):943–953
Hou JY, Kelly MG, Yu H et al (2007) Neoadjuvant chemotherapy lessens surgical morbidity in advanced ovarian cancer and leads to improved survival in stage IV disease. Gynecol Oncol 105(1):211–217
Chi DS, Palayekar MJ, Sonoda Y et al (2008) Nomogram for survival after primary surgery for bulky stage IIIC ovarian carcinoma. Gynecol Oncol 108(1):191–194
Engelen MJ, Kos HE, Willemse PH et al (2006) Surgery by consultant gynecologic oncologists improves survival in patients with ovarian carcinoma. Cancer 106(3):589–598
Yemelyanova AV, Cosin JA, Bidus MA et al (2008) Pathology of stage I versus stage III ovarian carcinoma with implications for pathogenesis and screening. Int J Gynecol Cancer 18(3):465–469
Galaal K, Kew FM, Tam KF et al (2009) Evaluation of prognostic factors and treatment outcomes in uterine carcinosarcoma. Eur J Obstet Gynecol Reprod Biol 143(2):88–92
Wu TI, Hsu KH, Huang HJ et al (2008) Prognostic factors and adjuvant therapy in uterine carcinosarcoma. Eur J Gynaecol Oncol 29(5):483–488
Nordal RR, Kristensen GB, Stenwig AE et al (1997) An evaluation of prognostic factors in uterine carcinosarcoma. Gynecol Oncol 67(3):316–321
van der Burg ME, van Lent M, Buyse M et al (1995) The effect of debulking surgery after induction chemotherapy on the prognosis in advanced epithelial ovarian cancer. Gynecological Cancer Cooperative Group of the European Organization for Research and Treatment of Cancer. N Engl J Med 332(10):629–634
Rose PG, Nerenstone S, Brady MF et al (2004) Secondary surgical cytoreduction for advanced ovarian carcinoma. N Engl J Med 351(24):2489–2497
Longo DL (2004) Repeat surgical debulking after three cycles of chemotherapy does not improve outcomes in advanced ovarian cancer. In: Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, Loscalzo J (eds) Harrison’s principles of internal medicine. McGraw-Hill, New York
Abood G, Bowen M, Potkul R et al (2008) Hepatic resection for recurrent metastatic ovarian cancer. Am J Surg 195(3):370–373 discussion 373
Bosquet JG, Merideth MA, Podratz KC, Nagorney DM (2006) Hepatic resection for metachronous metastases from ovarian carcinoma. HPB (Oxford) 8(2):93–96
Hamy AP, Paineau JR, Mirallie EC et al (2000) Hepatic resections for non-colorectal metastases: forty resections in 35 patients. Hepatogastroenterology 47(34):1090–1094
Eisenkop SM, Nalick RH, Wang HJ, Teng NN (1993) Peritoneal implant elimination during cytoreductive surgery for ovarian cancer: impact on survival. Gynecol Oncol 51(2):224–229
van Dam PA, Tjalma W, Weyler J et al (1996) Ultraradical debulking of epithelial ovarian cancer with the ultrasonic surgical aspirator: a prospective randomized trial. Am J Obstet Gynecol 174(3):943–950
van der Burg ME, Vergote I (2003) The role of interval debulking surgery in ovarian cancer. Curr Oncol Rep 5(6):473–481
Rahusen FD, Cuesta MA, Borgstein PJ et al (1999) Selection of patients for resection of colorectal metastases to the liver using diagnostic laparoscopy and laparoscopic ultrasonography. Ann Surg 230(1):31–37
Author information
Authors and Affiliations
Corresponding author
Additional information
S. I. Kamel and M. C. de Jong contributed equally to this work.
Rights and permissions
About this article
Cite this article
Kamel, S.I., de Jong, M.C., Schulick, R.D. et al. The Role of Liver-directed Surgery in Patients with Hepatic Metastasis from a Gynecologic Primary Carcinoma. World J Surg 35, 1345–1354 (2011). https://doi.org/10.1007/s00268-011-1074-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-011-1074-y