Objective: To describe a large single-center experience with hepatic resection for metastatic leiomyosarcoma.
Summary Background Data: Liver resection is the treatment of choice for hepatic metastases from colorectal carcinoma. In contrast, the role of liver resection for hepatic metastases from leiomyosarcoma has not been defined.
Methods: The records of 26 patients who between 1982 and 1996 underwent a total of 34 liver resections for hepatic metastases from leiomyosarcoma were reviewed. There were 23 first, 9 second, and 2 third liver resections. The records were analyzed with regard to survival and predictive factors.
Results: In the 23 first liver resections, there were 15 R0, 3 R1, and 5 R2 resections. Median survival was 32 months after R0 resection and 20.5 months after R1/2 resection. The 5-year survival rate was 13% for all patients and 20% after R0 resection. In 10 patients with extrahepatic tumor at the time of the first liver resection, 6 R0 and 4 R2 resections were achieved. After R0 resection, the median survival was 40 months (range 5–84 months), with a 5-year survival rate of 33%. After repeat liver resection, the median survival was 31 months (range 5–51 months); after R0 resection, median survival was 31 months and after R1/2 resection it was 28 months. There was no 5-year survivor in the overall group after repeat liver resection.
Conclusions: Despite frequent tumor recurrence, the long-term outcome after liver resection for hepatic metastases from leiomyosarcoma is superior to that after chemotherapy and chemoembolization. Although survival after tumor debulking also seems to be more favorable than after nonoperative therapy, these data indicate that only an R0 resection offers the chance of long-term survival. The presence of extrahepatic tumor should not be considered a contraindication to liver resection if complete removal of all tumorous masses appears possible. In selected cases of intrahepatic tumor recurrence, even repeated liver resection might be worthwhile. In view of the poor results of chemoembolization and chemotherapy in hepatic metastases from leiomyosarcoma, liver resection should be attempted whenever possible.
The liver is a common site of metastases from gastrointestinal or retroperitoneal leiomyosarcoma. However, hepatic recurrence is uncommon after curative surgery of primary sarcomas on the trunk or extremities. 1 Because metastases from leiomyosarcoma are usually not sensitive to chemotherapy or chemoembolization, the outcome is often poor, with only short survival. Without treatment, the median survival of patients with liver metastases is no more than 14 months. 2,3
Although in recent years hepatic resection has become a safe procedure, with a surgical death rate of less than 5% in most series, there are few data on liver resection for noncolorectal, nonneuroendocrine metastases. In view of the limited number of therapeutic options for hepatic metastases from leiomyosarcoma, an aggressive surgical approach to this tumor in an attempt to improve the otherwise poor prognosis appears justified. In this report we present our experience with hepatic resection for liver metastases from leiomyosarcoma.
From *Klinik für Abdominal- und Transplantationschirurgie, and †Abteilung für Pathologie, Medizinische Hochschule Hannover, Hannover, Germany
Correspondence: Hauke Lang, MD, Klinik und Poliklinik für Allg. und Transplantationschirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45122 Essen, Germany.
Accepted for publication November 10, 1999.