Liver resection of noncolorectal secondaries

Hepatic resection of noncolorectal metastases appears to be performed with increasing frequency. Reported experience is limited and indications are controversial.

Retrospective review of curative hepatic resection in 32 patients (median age 58 years) during 1970-1995. The primary tumor was a carcinoid in seven patients, other endocrine tumor in five patients, malignant melanoma in three patients, stomach cancer in three patients, exocrine pancreatic cancer in two patients, gynecological cancer in two patients, sarcoma in two patients, and miscellaneous in eight patients. Seven patients (22%) had bilobar disease and 12 patients (38%) had extrahepatic growth.

Median survival was 32 months, and 5-year actuarial survival rate was 36% (including operative mortality). Median survival in the endocrine (n = 12) and nonendocrine (n = 20) groups was 72 and 18 months, respectively (corresponding 5-year survival rates were 56 and 25%) (P = 0.16). Prognostic factors could not be established in either group. It is, however, noteworthy that no patient with nonendocrine secondaries and more than one liver tumor or extrahepatic disease survived for 5 years. Major complications were seen in eight patients (25%), including three postoperative deaths (operative mortality 9%) occurring during the first 5 years of the study period.

Hepatic resection of metastases from endocrine primary tumors was followed by long-term survival in a substantial proportion of patients. Long-term survival for patients with nonendocrine tumors was observed only when there was a single liver tumor and no extrahepatic growth. Further experience is needed for definition of resection criteria.