title: Liver resection for metastatic soft tissue sarcoma: an analysis of prognostic factors.
abstract: OBJECTIVE
  The aim of this retrospective study was to analyse the outcome following hepatic resection for metastatic STS and to identify factors predicting survival.
  
  
  METHODS
  All patients who underwent hepatic resection for metastatic STS between August 1997 and April 2009 were included. The data was obtained from a prospectively maintained database. Patients' demographics, clinico-pathological parameters, overall survival and the factors predicting survival were analysed.
  
  
  RESULTS
  Thirty-six patients underwent hepatic resection for metastasis, with a median age of 58 years. The predominant site of primary tumour was the gastro-intestinal tract (50%). Leiomyosarcoma was the most common histological type (54%). The median interval between the primary and metastatic resections was 17 months. Thirteen patients had synchronous tumours. 24 patients had major liver resections and 10 patients had bi-lobar disease. The median number of liver lesions resected was 1(1-6) and the median maximum diameter was 11 cm (1-26 cm). R0 resection was performed in 31 patients. The 1-, 3- and 5-year overall survival from the time of metastasectomy was 90.3%, 48.0% and 31.8% respectively, with a median survival of 24 months. Factors associated with poor survival on univariate analysis were the presence of high grade tumours (p = 0.04), primary leiomyosarcoma (p = 0.01) and positive resection margin of liver metastasis (p = 0.04), whilst multivariate analysis predicted primary leiomyosarcoma as a risk factor for poor survival (p = 0.01).
  
  
  CONCLUSIONS
  Hepatic resection for metastatic STS appears to be valuable in carefully selected patients with acceptable long-term survival. The aim of surgery must be an R0 resection to offer a chance of cure.
authors.affiliation: Department of Hepatobiliary and Transplantation Surgery, Liver Unit, Queen Elizabeth Hospital, University Hospital of Birmingham NHS Foundation Trust, Birmingham, UK.
authors.forename: R
authors.initials: R
authors.lastname: Marudanayagam
authors.forename: B
authors.initials: B
authors.lastname: Sandhu
authors.forename: M T P R
authors.initials: MT
authors.lastname: Perera
authors.forename: S R
authors.initials: SR
authors.lastname: Bramhall
authors.forename: D
authors.initials: D
authors.lastname: Mayer
authors.forename: J A C
authors.initials: JA
authors.lastname: Buckels
authors.forename: D F
authors.initials: DF
authors.lastname: Mirza
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000473:pathology*; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012509:Sarcoma / Q000556:secondary / Q000601:surgery*; D016019:Survival Analysis; D055815:Young Adult