Role of surgical resection for non-colorectal non-neuroendocrine liver metastases

It is widely accepted that the indications for hepatectomy in colorectal cancer liver metastases and liver metastases of neuro-endocrine tumors result in relatively better prognoses, whereas, the indications and prognoses of hepatectomy for non-colorectal non-neuroendocrine liver metastases (NCNNLM) remain controversial owing to the limited number of cases and the heterogeneity of the primary diseases. There have been many publications on NCNNLM; however, its background heterogeneity makes it difficult to reach a specific conclusion. This heterogeneous disease group should be discussed in the order from its general to specific aspect. The present review paper describes the general prognosis and risk factors associated with NCNNLM while specifically focusing on the liver metastases of each primary disease. A multidisciplinary approach that takes into consideration appropriate timing for hepatectomy combined with chemotherapy may prolong survival and/or contribute to the improvement of the quality of life while giving respite from systemic chemotherapy.

Long-term results of hepatic resection for non-colorectal, non-neuroendocrine liver metastasis

BACKGROUND/AIMS

The significance of surgical resection for non-colorectal non-neuroendocrine tumor liver metastasis (NCNNLM) remains controversial. The present study sought to clarify the long-term outcomes of surgical resection for NCNNLM and prognostic factors after hepatectomy in a single institution.

METHODOLOGY

From 1993 to 2009, 145 patients underwent hepatectomy for NCNNLM. The primary sites of the hepatic tumors were gastrointestinal carcinoma in 80 cases, breast in 30, genitourinary in 12, gastrointestinal stromal tumor in 11, and miscellaneous in 12.

RESULTS

The cumulative 1-, 3-, and 5-year overall survival rates of those who underwent hepatectomy for NCNNLM were 83.9, 55.4, and 41.0%, respectively, with median overall survival times of 41.8 months. Multivariate analysis revealed that postoperative complication was the only independent poor prognostic factor impacting on survival. Postoperative morbidity and mortality rate were 17.9% and 1.4%. There are 38 cases survived more than 5 years including 21 patients without remnant tumors due to the repeat hepatic and/or pulmonary resection for recurrence. A total of 32 patients survived without tumor and without any kinds of chemotherapy in the latest condition.

CONCLUSIONS

Hepatectomy for NCNNLM may be beneficial and might relieve patients from excursive chemotherapy in selected patients. Meticulous surgery avoiding complication may enhance the outcome.

Eleven-year survivor of unresectable intrahepatic cholangiocarcinoma treated using long-term UFT therapy

We report a 49-year-old man with unresectable intrahepatic cholangiocarcinoma (ICC) who was treated with oral tegafur-uracil (UFT) chemotherapy and survived for over a decade. In 1995, the patient was admitted to our institution after a large tumor in his left liver was detected using computed tomography (CT). The tumor was diagnosed as ICC, and a laparotomy was performed; however, the tumor was too advanced to perform a curative resection. The cancer had spread to the lymph nodes in the hepatoduodenal ligament and on the posterior surface of the pancreas head. A curative resection was abandoned, and oral UFT chemotherapy was started immediately after the laparotomy. The tumor remained almost unchanged until 2001 with only UFT administration; however, its size gradually increased to 7.8 cm in diameter. External-beam radiotherapy (50.4 Gy) was performed, and the tumor's size decreased to 6.3 cm in diameter. Eleven years have now passed since the laparotomy, and the patient continues to lead a normal daily life working as a banker. The cumulative dose of UFT has reached 2511 g without any significant adverse effects. This case suggests that oral UFT might suppress the progression of ICC, contributing to this patient's 11-year survival period.