title: Surgical management of breast cancer liver metastases.
abstract: BACKGROUND
  Selected patients with isolated breast cancer liver metastases (BCLM) may benefit from surgical management; however, indications remain unclear and the risks may outweigh the benefits in patients with a generally poor prognosis.
  
  
  METHODS
  Between 1998 and 2006, 17 patients diagnosed with BCLM were considered for surgical management (<4 tumours, tumour <4 cm in diameter and no/stable extrahepatic metastases). Peri-operative and outcomes data were analysed and compared.
  
  
  RESULTS
  Eight patients were found to have extensive or untreatable disease on staging laparoscopy and intra-operative ultrasound (SL/IOUS). The remaining nine patients underwent surgical management [seven laparoscopic radiofrequency ablations (RFA) and two hepatic resections]. Median length of follow-up for patients treated surgically was 40.0 months, median disease-free survival (DFS) was 32.2 months and median time to disease progression was 17.7 months. Of the eight patients not amenable to surgery, median length of follow-up was 21.8 months.
  
  
  CONCLUSIONS
  SL/IOUS prevented unnecessary laparotomy in half of the patients taken to the operating room for surgical treatment of BCLM. In patients with BCLM, SL/IOUS should be considered standard of care before surgical intervention. The small number of patients and short follow-up may be inadequate to determine the true value of surgical management in this group of patients with BCLM.
authors.affiliation: Liver and Pancreas Surgery Program, Providence Portland Medical Center Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, Portland, Oregon 97213, USA.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Cassera
authors.forename: Chet W
authors.initials: CW
authors.lastname: Hammill
authors.forename: Michael B
authors.initials: MB
authors.lastname: Ujiki
authors.forename: Ronald F
authors.initials: RF
authors.lastname: Wolf
authors.forename: Lee L
authors.initials: LL
authors.lastname: Swanström
authors.forename: Paul D
authors.initials: PD
authors.lastname: Hansen
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology*; D017115:Catheter Ablation / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006801:Humans; D010535:Laparoscopy; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008875:Middle Aged; D009367:Neoplasm Staging; D009922:Oregon; D018579:Patient Selection; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography