gms | German Medical Science

Background: The aim of this study was to find out which items characterize patients who live longer than five years after surgical therapy of non-colorectal, non-neuroendocrine liver metastases.

Materials and methods: Clinical, pathological and follow-up data of all patients with non-colorectal, non-neuroendocrine liver metastases who were registered in our clinical cancer registry were extracted and analyzed.

Results: From 1995 to 2014, 221 patients with non-colorectal, non-neuroendocrine liver metastases where seen in our surgical clinic. The primary tumors were breast cancer in 62, kidney cancer in 32, stomach cancer in 27, ovary cancer in 18, pancreatic cancer in 17, cervical and uterine cancer in 10, lung cancer in 9, and miscellaneous cancer in 46 patients. In all but two patients a curative intervention was planned. An R0-resection could be realized in 115 patients (52%) only, due to unexpected intra- or extrahepatic tumor manifestations. 42 patients underwent an explorative laparotomy only. 22 patients had a liver resection with gross tumor left behind, 17 a liver resection with positive margins only, and 23 had an ablative therapy with or without liver resection. Among the 184 patients with local interventions, the median time interval between primary and liver metastases treatment was 22 months (range 0-271 months). In 68 patients (37%) liver metastases were diagnosed within the first year after diagnosis of the primary tumor.

After a median follow-up time of 20 months for the 184 patients with local intervention, 5-year survival rates for R0-, R1/2-resection, and ablative therapy were 28%, 13%, and 17% respectively and did not differ not statistically significant. 10-year survival rates for R0-, R1/2-resection were 10%, 0%, and 11% respectively, corresponding median survival times 28, 17, and 12 months. 7 patients had survived ten years or more after local liver therapy, 30 patients five to ten years. Table 1 [Tab. 1] shows the major characteristics of the 30 five-year survivors. Considering the primary tumor, 5-year survival rates for kidney cancer, breast cancer, gastrointestinal cancer, lung cancer and pancreatic cancer were 38%, 28%, 25%, 14% and 0% respectively.

In Addition, 12 of the five-year survivors showed liver metastases within one year after diagnosis of the primary tumor, and 10 had extrahepatic tumor at the time of liver therapy. During follow up, 17 of the five-year survivors suffered a local or distant recurrence of tumor.

Conclusion: The overall survival rates cancer in the whole study group depend on the frequency of the different types of primary cancers. Best long term results after surgical treatment for non-colorectal, non-neuroendocrine liver metastases are achievable for breast cancer, and kidney cancer patients. But we saw 5-year survivors even after treatment of patients with synchronous metastases, gastrointestinal primaries, multiple metastases, and extrahepatic tumor. Therefore local therapy of non-colorectal, non-neuroendocrine liver metastases can be recommended regardless of these properties.