Changes in indication and results after resection of hepatic metastases from noncolorectal primary tumors: a single-institutional review.
BACKGROUND
The isolated occurrence of noncolorectal liver metastases is rare. The available data are inconsistent in terms of indication for surgery, treatment, and outcome, so a generally applicable therapeutic algorithm is currently lacking.


METHODS
A total of 162 patients underwent resection for noncolorectal liver metastases between 1978 and 2001. The patients were divided into two groups from different time periods (group 1, 1978-1989; group 2, 1990-2001) that were similar in terms of number of patients, operating surgeons, and surgical techniques used. The groups were compared, and the data were retrospectively analyzed with regard to indication, survival, and factors predictive for survival.


RESULTS
Resection was performed to remove liver metastases from noncolorectal gastrointestinal carcinoma (n = 50), neuroendocrine tumors (n = 12), genitourinary primary tumors (n = 11), breast carcinoma (n = 24), leiomyosarcoma (n = 15), and metastases from other primary cancers (n = 50). Extrahepatic tumor involvement was seen in 38 (23%) of the 162 cases. Sixty-two (38%) major hepatectomies and 100 (62%) minor resections were performed. In 100 (62%) of 162 patients, a curative resection (R0) could be achieved. Overall 2- and 5-year survival rates of 49% and 26%, respectively, were observed, and the median survival was 23 months. Survival was significantly longer in patients who underwent an R0 resection.


CONCLUSIONS
In selected patients, resection of noncolorectal liver metastases is associated with a 5-year survival rate of up to 50%. Resection of liver metastases from gastrointestinal adenocarcinomas correlates with a poor prognosis. Extrahepatic metastases may be considered a relative contraindication for liver resection.
Yedibela
Süleyman
S
Department of Surgery, University of Erlangen, Krankenhausstrasse,12, Erlangen, D-91054, Germany. suleyman.yedibela@chir.med.uni-erlangen.de
Gohl
Jonas
J
Graz
Valentina
V
Pfaffenberger
Mona Kathrin
MK
Merkel
Susanne
S
Hohenberger
Werner
W
Meyer
Thomas
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000473:pathology; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000473:pathology; D018579:Patient Selection; D012189:Retrospective Studies; D014565:Urogenital Neoplasms / Q000473:pathology