The role of liver-directed surgery in patients with hepatic metastasis from primary breast cancer

A multi-institutional analysis

Georgios A. Margonis, Stefan Buettner, Kazunari Sasaki, Yuhree Kim, Francesca Ratti, Nadia Russolillo, Alessandro Ferrero, Nickolas Berger, T. Clark Gamblin, George Poultsides, Thuy Tran, Lauren M. Postlewait, Shishir Maithel, Alex D. Michaels, Todd W. Bauer, Hugo Marques, Eduardo Barroso, Luca Aldrighetti, Timothy M. Pawlik

Research output: Contribution to journalArticle

Abstract

Background: Data on surgical management of breast liver metastasis are limited. We sought to determine the safety and long-term outcome of patients undergoing hepatic resection of breast cancer liver metastases (BCLM). Methods: Using a multi-institutional, international database, 131 patients who underwent surgery for BCLM between 1980 and 2014 were identified. Clinicopathologic and outcome data were collected and analyzed. Results: Median tumor size of the primary breast cancer was 2.5 cm (IQR: 2.0-3.2); 58 (59.8%) patients had primary tumor nodal metastasis. The median time from diagnosis of breast cancer to metastasectomy was 34 months (IQR: 16.8-61.3). The mean size of the largest liver lesion was 3.0 cm (2.0-5.0); half of patients (52.0%) had a solitary metastasis. An R0 resection was achieved in most cases (90.8%). Postoperative morbidity and mortality were 22.8% and 0%, respectively. Median and 3-year overall-survival was 53.4 months and 75.2%, respectively. On multivariable analysis, positive surgical margin (HR 3.57, 95% CI 1.40-9.16; p = 0.008) and diameter of the BCLM (HR 1.03, 95% CI 1.01-1.06; p = 0.002) remained associated with worse OS. Discussion: In selected patients, resection of breast cancer liver metastases can be done safely and a subset of patients may derive a relatively long survival, especially from a margin negative resection.

Original languageEnglish (US)
JournalHPB
DOIs
StateAccepted/In press - Apr 3 2016

Fingerprint

Breast Neoplasms
Neoplasm Metastasis
Liver Neoplasms
Liver
Metastasectomy
Survival
Neoplasms
Breast
Databases
Morbidity
Safety
Mortality
Margins of Excision

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Margonis, G. A., Buettner, S., Sasaki, K., Kim, Y., Ratti, F., Russolillo, N., ... Pawlik, T. M. (Accepted/In press). The role of liver-directed surgery in patients with hepatic metastasis from primary breast cancer: A multi-institutional analysis. HPB. https://doi.org/10.1016/j.hpb.2016.05.014

The role of liver-directed surgery in patients with hepatic metastasis from primary breast cancer : A multi-institutional analysis. / Margonis, Georgios A.; Buettner, Stefan; Sasaki, Kazunari; Kim, Yuhree; Ratti, Francesca; Russolillo, Nadia; Ferrero, Alessandro; Berger, Nickolas; Gamblin, T. Clark; Poultsides, George; Tran, Thuy; Postlewait, Lauren M.; Maithel, Shishir; Michaels, Alex D.; Bauer, Todd W.; Marques, Hugo; Barroso, Eduardo; Aldrighetti, Luca; Pawlik, Timothy M.

In: HPB, 03.04.2016.

Research output: Contribution to journalArticle

Margonis, GA, Buettner, S, Sasaki, K, Kim, Y, Ratti, F, Russolillo, N, Ferrero, A, Berger, N, Gamblin, TC, Poultsides, G, Tran, T, Postlewait, LM, Maithel, S, Michaels, AD, Bauer, TW, Marques, H, Barroso, E, Aldrighetti, L & Pawlik, TM 2016, 'The role of liver-directed surgery in patients with hepatic metastasis from primary breast cancer: A multi-institutional analysis', HPB. https://doi.org/10.1016/j.hpb.2016.05.014
Margonis, Georgios A. ; Buettner, Stefan ; Sasaki, Kazunari ; Kim, Yuhree ; Ratti, Francesca ; Russolillo, Nadia ; Ferrero, Alessandro ; Berger, Nickolas ; Gamblin, T. Clark ; Poultsides, George ; Tran, Thuy ; Postlewait, Lauren M. ; Maithel, Shishir ; Michaels, Alex D. ; Bauer, Todd W. ; Marques, Hugo ; Barroso, Eduardo ; Aldrighetti, Luca ; Pawlik, Timothy M. / The role of liver-directed surgery in patients with hepatic metastasis from primary breast cancer : A multi-institutional analysis. In: HPB. 2016.
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abstract = "Background: Data on surgical management of breast liver metastasis are limited. We sought to determine the safety and long-term outcome of patients undergoing hepatic resection of breast cancer liver metastases (BCLM). Methods: Using a multi-institutional, international database, 131 patients who underwent surgery for BCLM between 1980 and 2014 were identified. Clinicopathologic and outcome data were collected and analyzed. Results: Median tumor size of the primary breast cancer was 2.5 cm (IQR: 2.0-3.2); 58 (59.8{\%}) patients had primary tumor nodal metastasis. The median time from diagnosis of breast cancer to metastasectomy was 34 months (IQR: 16.8-61.3). The mean size of the largest liver lesion was 3.0 cm (2.0-5.0); half of patients (52.0{\%}) had a solitary metastasis. An R0 resection was achieved in most cases (90.8{\%}). Postoperative morbidity and mortality were 22.8{\%} and 0{\%}, respectively. Median and 3-year overall-survival was 53.4 months and 75.2{\%}, respectively. On multivariable analysis, positive surgical margin (HR 3.57, 95{\%} CI 1.40-9.16; p = 0.008) and diameter of the BCLM (HR 1.03, 95{\%} CI 1.01-1.06; p = 0.002) remained associated with worse OS. Discussion: In selected patients, resection of breast cancer liver metastases can be done safely and a subset of patients may derive a relatively long survival, especially from a margin negative resection.",
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T1 - The role of liver-directed surgery in patients with hepatic metastasis from primary breast cancer

T2 - A multi-institutional analysis

AU - Margonis, Georgios A.

AU - Buettner, Stefan

AU - Sasaki, Kazunari

AU - Kim, Yuhree

AU - Ratti, Francesca

AU - Russolillo, Nadia

AU - Ferrero, Alessandro

AU - Berger, Nickolas

AU - Gamblin, T. Clark

AU - Poultsides, George

AU - Tran, Thuy

AU - Postlewait, Lauren M.

AU - Maithel, Shishir

AU - Michaels, Alex D.

AU - Bauer, Todd W.

AU - Marques, Hugo

AU - Barroso, Eduardo

AU - Aldrighetti, Luca

AU - Pawlik, Timothy M.

PY - 2016/4/3

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N2 - Background: Data on surgical management of breast liver metastasis are limited. We sought to determine the safety and long-term outcome of patients undergoing hepatic resection of breast cancer liver metastases (BCLM). Methods: Using a multi-institutional, international database, 131 patients who underwent surgery for BCLM between 1980 and 2014 were identified. Clinicopathologic and outcome data were collected and analyzed. Results: Median tumor size of the primary breast cancer was 2.5 cm (IQR: 2.0-3.2); 58 (59.8%) patients had primary tumor nodal metastasis. The median time from diagnosis of breast cancer to metastasectomy was 34 months (IQR: 16.8-61.3). The mean size of the largest liver lesion was 3.0 cm (2.0-5.0); half of patients (52.0%) had a solitary metastasis. An R0 resection was achieved in most cases (90.8%). Postoperative morbidity and mortality were 22.8% and 0%, respectively. Median and 3-year overall-survival was 53.4 months and 75.2%, respectively. On multivariable analysis, positive surgical margin (HR 3.57, 95% CI 1.40-9.16; p = 0.008) and diameter of the BCLM (HR 1.03, 95% CI 1.01-1.06; p = 0.002) remained associated with worse OS. Discussion: In selected patients, resection of breast cancer liver metastases can be done safely and a subset of patients may derive a relatively long survival, especially from a margin negative resection.

AB - Background: Data on surgical management of breast liver metastasis are limited. We sought to determine the safety and long-term outcome of patients undergoing hepatic resection of breast cancer liver metastases (BCLM). Methods: Using a multi-institutional, international database, 131 patients who underwent surgery for BCLM between 1980 and 2014 were identified. Clinicopathologic and outcome data were collected and analyzed. Results: Median tumor size of the primary breast cancer was 2.5 cm (IQR: 2.0-3.2); 58 (59.8%) patients had primary tumor nodal metastasis. The median time from diagnosis of breast cancer to metastasectomy was 34 months (IQR: 16.8-61.3). The mean size of the largest liver lesion was 3.0 cm (2.0-5.0); half of patients (52.0%) had a solitary metastasis. An R0 resection was achieved in most cases (90.8%). Postoperative morbidity and mortality were 22.8% and 0%, respectively. Median and 3-year overall-survival was 53.4 months and 75.2%, respectively. On multivariable analysis, positive surgical margin (HR 3.57, 95% CI 1.40-9.16; p = 0.008) and diameter of the BCLM (HR 1.03, 95% CI 1.01-1.06; p = 0.002) remained associated with worse OS. Discussion: In selected patients, resection of breast cancer liver metastases can be done safely and a subset of patients may derive a relatively long survival, especially from a margin negative resection.

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