Liver metastases from breast cancer: the role of surgical treatment

BACKGROUND/AIMS

To evaluate short- and long-term outcomes in the surgical treatment of liver metastases from breast cancer

METHODOLOGY

Between 1984 and 1999 we observed 26 patients with secondary liver localization (25 metachronous) from breast cancer. The median disease-free interval was 70 months (4-136). Median age at the time of liver surgery was 56 years (36-76). The 18 patients included: 1 patient at stage 1, 10 at IIA, 6 stage II B and 1 patient at stage IV. Seven patients were found to have axillary lymph nodes metastases. Fifteen patients had infiltrating ductal carcinoma, 2 a lobular carcinoma and 1 patient a mixed-component carcinoma. The grading was G3 in 10 and G2 in 8 patients. Regarding the recettorial status, 5 patients were ER+ PR-, 8 patients were ER+PR-, 4 patients were ER-PR-. In 9 cases the patients underwent adjuvant chemotherapy (5 of them following postoperative radiotherapy) and in 14 cases Tamoxifen was used. Surgery was conservative in 13 cases and demolitive in 5 cases.

RESULTS

The follow-up (3-70 months) was completed in 15 patients out of 18 observed cases. Nine patients died; six patients are still living, 4 of them "disease-free", 2 having advanced metastatic disease, in treatment. There was neither long-term or perioperative major morbidity nor mortality in our group. The overall 5-year-survival was 25% in patients whose liver metastases developed within 3 years after breast surgery compared with 40% in those ones with metastatic disease diagnosed more than 3 years after.

CONCLUSIONS

Surgery of liver metastases from breast cancer can be performed with low morbidity and mortality in selected patients.

[Thyroid carcinoma: evaluation of prognostic factors]

Between 1990 and 1997, 36 thyroid cancer patients were observed at the III Department of Surgical Oncology, Regina Elena Cancer Institute in Rome. There were 31 (86.1%) women and 5 (13.9%) men, with a mean age of 47.7 years (range 17-72). Diagnostic data consisted of: papillary carcinoma in 25 patients, follicular carcinoma in 9 and Hürthle cell carcinoma in 1. Twenty patients were less than 45 years old (15 papillary and 5 follicular carcinoma) and 16 were more than 45 years old (10 papillary and 4 follicular carcinoma, 1 Hürthle cell carcinoma and 1 with undifferentiated cancer). We performed total thyroidectomy in 32 cases and isthmectomy in 3 (2 papillary carcinoma, T1, < 45 years, 1 follicular carcinoma with minimal invasion). At the time of diagnosis, 6 patients with papillary carcinoma showed signs of local metastasis. No patients exhibited distant diffusion. A follow-up was performed at mean 41 months (2-84 months). Two patients with follicular carcinomas had been treated with radioiodine and showed disease progression with distant metastasis. Our results coincide with the literature on this topic. Total thyroidectomy is preferred, in low-risk patients as well, because subsequent radioiodine treatment and disease relapse monitoring are facilitated. Lateral cervical lymphadenectomy was performed only in cases when there was clinical evidence of metastasis and recurrent disease at this level has never been observed.

[Carcinoma of the gastric stump. Our experience in 28 treated cases]

A chart review was conducted on 28 patients with gastric stump cancer who were radically treated at the First Department of Surgery of University "La Sapienza" of Rome between 1978 and 1990. The data obtained were compared with those of 401 patients radically treated, in the same period, for primary cancer of the proximal third of the stomach. There were no significant differences between the two groups in terms of stage and nodal involvement. Surgical treatment was total gastrectomy in 86% of cases, and an extended procedure in 57% of patients. The morbidity rate was similar to patients treated for primary gastric cancer, as well the 5-year survival, which depend on the stage of disease. We can conclude that gastric stump cancer must be treated surgically with radical intent as the prognosis is similar to that of primary gastric cancer.

[The role of colonoscopy in early diagnosis of intraluminal recurrences in patients already treated for colorectal cancer]

It is a common opinion that the more often and the more rigorously the colon is examined, the more lesions will be discovered and diagnosed. However it has not been shown which methods of colonic examination and which regimen of surveillance should be used. Chart review was conducted on 481 patients who underwent curative resection for colorectal cancer between 1980 and 1990. Colonoscopy was performed preoperatively, after 12-15 months from surgical treatment, and then at an interval of 12-24 months, or when symptoms appeared. About ten percent of patients developed intraluminal recurrences, and more than 25% adenomatous polyps. More than one half of the metachronous lesions arise within the first 24 months. The median time to diagnosis was 25 months for intraluminal recurrences and 22 months for adenomatous polyps. Patients with left sited tumor at an advanced stage run a higher risk of developing recurrent intraluminal disease, and patients who presented associated polyps at the time of the operation for the index cancer have a higher risk of developing new polyps. About 50% of recurrences were detected when patients were asymptomatic. Colonoscopy must be performed within the first 12-15 months after operation, while an interval of 24 months between each examination seems sufficient to guarantee an early detection of metachronous lesion. Asymptomatic patients are more frequently reoperated for cure and thus have a better survival rate.