title: Repeat Hepatectomy for Breast Cancer Liver Metastases.
abstract: BACKGROUND
  Resection of breast cancer liver metastases (BCLM) combined with systemic treatment is increasingly accepted as a therapeutic option; however, the potential benefit of repeat hepatectomy for recurrent BCLM is unknown.
  
  
  METHODS
  All consecutive female patients who underwent liver resection for BCLM at our center between January 1985 and December 2012 were included. Patients who had a single hepatectomy (N = 120) were compared with those who also underwent repeat hepatectomy (N = 19). Patients were selected for repeat hepatectomy based on operability and disease control. Prognostic factors of survival after repeat hepatectomy were determined.
  
  
  RESULTS
  Median overall survival since first hepatectomy was 35 months, with a 3- and 5-year survival rate of 50 and 38 %, respectively. Overall survival following repeat hepatectomy was 64 and 46 % at 3 and 5 years, respectively. From the time of first hepatectomy, patients who underwent repeat hepatectomy had a better survival than those who had only one hepatectomy (95 and 84 vs. 50 and 38 % at 3 and 5 years, respectively) (p = 0.002). Median survival was 35 and 100 months, respectively, and median survival since the diagnosis of BCLM was 51 and 112 months in the single and repeat hepatectomy groups, respectively. Since the time of diagnosis, overall 3-, 5-, and 7-year survival rates were 75, 57, and 44 %, respectively, for all 139 patients. Improved overall survival after repeat hepatectomy was related to a time interval between breast cancer diagnosis and first hepatectomy of >2 years, a limited hepatectomy, solitary liver metastasis, positive progesterone receptor status, and chemotherapy following repeat hepatectomy. Patients with single BCLM at first hepatectomy had a 3- and 5-year overall survival rate of 76 and 76 % compared with 51 and 17 % in patients with multiple metastases (p = 0.023).
  
  
  CONCLUSIONS
  In selected patients with BCLM, repeat hepatectomy for liver recurrence combined with systemic treatment provided survival rates comparable to those after first hepatectomy.
authors.affiliation: Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France.|Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Aldrick
authors.initials: A
authors.lastname: Ruiz
authors.affiliation: Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France.|Department of Surgery, Hospital Mexico, San Jose, Costa Rica.
authors.forename: Carlos
authors.initials: C
authors.lastname: Castro-Benitez
authors.affiliation: Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France.
authors.forename: Mylène
authors.initials: M
authors.lastname: Sebagh
authors.affiliation: Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France.|Département de Cancérologie, APHP, Hopital Saint Louis, Paris, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Giacchetti
authors.affiliation: Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France.|National Center for Transplantation and Hepato-Panacreato-Biliary Surgery of Costa Rica, San Jose, Costa Rica.
authors.forename: Edward
authors.initials: E
authors.lastname: Castro-Santa
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Wicherts
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Richard
authors.initials: R
authors.lastname: van Hillegersberg
authors.affiliation: Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Paule
authors.affiliation: Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France.|Inserm, Université Paris-Sud, UMR-S 785, Villejuif, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Castaing
authors.affiliation: Département de Cancérologie, AP-HP Hôpital Paul Brousse, Villejuif, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Morère
authors.affiliation: Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France. rene.adam@pbr.aphp.fr.|Inserm, Université Paris-Sud, UMR-S 776, Villejuif, France. rene.adam@pbr.aphp.fr.
authors.forename: René
authors.initials: R
authors.lastname: Adam
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D012086:Reoperation; D015996:Survival Rate