Liver resections from breast cancer metastasis: results and prognosis factors after hepatic resection in 65 cases.

Study aim: To report results of liver resections for breast cancer liver me tastasis (BCLM) and to evaluate the rate of survival and the prognostic fac tors. Patients and method: Between 1988 and 1999, 69 patients were operated on fo r BCLM and 65 who had liver resection were analyzed. The selection criteria for surgery were: normal performance status and liver function test; radio logical objective response to chemotherapy (and/or hormonotherapy); in case s of non-isolated BCLM, complete response of associated metastatic site (us ually bone) and no brain metastases. The mean age of the 65 patients was 47 (30-70) years. BCLM was diagnosed an average of 60 (0-205) months after th e initial cancer. The BCLM was more frequently solitary (n = 44). The mean diameter was 3.8 (0-12) cm, The mean number of cycles of chemotherapy befor e surgery was 7.5 (3-24). Liver resections included major hepatectomy (n = 31): right n = 19, extended left n = 4, left n = 8, minor hepatectomy (n = 25) and limited resection in = 9). Results: There was no postoperative mortality. The 18% morbidity rate inclu ded a majority of pleural effusions with two reoperations. The median follo w-up was 41 months (6-100 months). The survival rate after surgery was 90% at 1 year, 71% at 3 and 46% at 4 years. Thirteen patients are alive at 4 ye ars. The 36-month survival rate differed according to the time to onset of BCLM: 55% before versus 86% after 48 months (p = 0.01). The other studied f actors were not statistically associated with survival. The recurrence rate in the remaining liver at 36 months differed according to the lymph node s tatus of the initial breast cancer: 40% for N0-N1 versus 81% for N1b-N2 (p = 0.01) and according to the type of liver resection: 45% for minor liver r esection versus 73% for major (p = 0.02). Conclusion: Adjuvant liver surgery should be included in multicenter treatm ent protocols for medically-control led breast cancer liver metastasis. (C) 2001 Editions scientifiques et medicales Elsevier SAS.