[Hepatic resection for breast cancer metastasis. The concept of adjuvant surgery]

Surgery for hepatic metastases from breast cancer remains anecdotal and controversial. This retrospective series of 21 patients analyses survival after hepatic resection. These patients presented with isolated metachronous metastases, controlled by systemic treatment; surgery was considered to be an adjuvant treatment. There was no surgical mortality. The TNM stage of the initial breast cancer, the time to onset of metastases and the number of hepatic metastases did not influence survival. The 5-year survival, after diagnosis of metastatic disease, was 60%; clearly better than the expected survival. Eleven patients are currently alive without recurrence. Six patients developed a recurrence in the remaining liver after a mean interval of 12 months, including 4 patients who died after a mean interval of 49 months. These results suggest that a subgroup of patients with hepatic metastases from breast cancer may benefit from surgical resection. This surgery must be proposed in patients with isolated disease progression controlled by systemic treatment. In our experience, adjuvant surgery of hepatic metastases from breast cancer is followed by an uneventful postoperative course, improves survival and, in 50% of cases, allows discontinuation of chemotherapy, improving the patient's quality of life.