Posters— Surgical Treatment of Sarcomas

LIVER RESECTION FOR METASTATIC SOFT-TISSUE SARCOMAS

van Ruth S, Mutsaerts E, van Coevorden F. Department of Surgery, Netherlands Cancer Institute / Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands

Introduction: Involvement of the liver as a metastatic site of soft-tissue sarcomas (STS) is found in less than 10% of the all STS patients. Usually it concerns visceral or retroperitoneal STS. Untreated, the median survival is about 12 months. Chemotherapy, especially for GIST tumors, shows disappointing results. In the literature resection of STS liver metastases shows prolonged survival. 5-year survival is 10-20%. We selected the data of patients undergoing surgery in our institute for metastatic STS. Aims of the study: The aims of this study are to evaluate the outcome of liver resection performed on patients with STS liver metastases and compare them with results of colorectal and other non-colorectal liver metastases. Endpoints are perioperative mortality and morbidity, postoperative hospital stay, disease free and overall survival.

Patients and methods: From our prospective hepatic surgery database the files of patients with metastatic disease were selected. Pathological and surgical reports of the STS cases were analyzed. Of all patients follow-up data were obtained. Survival was calculated according to the Kaplan-Meier method.

Results: Six patients with a mean age of 59 (45-65) years underwent hepatic resection and one patient underwent repeated metastasectomy for recurrent hepatic disease 4 years later. Primary localization of the STS was the lower extremity (n=l, pleomorphic sarcoma), intestines (stomach (n=l, GIST), rectum (n=3, GIST)) and retroperitoneurn (n=l, leiomyosarcoma). The median disease free interval between primary STS and liver metastases was 48 (0-144) months. Surgical procedures included right hemiliepatectomy (n=l), right hemiliepatectomy combined with segment I resection (n=l) and five segmental resections (V/Vl, IV, IV, VII, VIII). All metastasectornies had clear margins. There was no mortality. One major complication occurred: relaparotomy was necessary because of p.o. hemorrhage. The median postoperative hospital stay was 14 (8-24) days. The median post resection survival was 32 (9-68) months. Two patients died of their malignancy (new hepatic metastases n=2, one of them with concomitant extrahepatic metastases), four patients are still alive, two with evidence of disease (hepatic metastases n=l, extrahepatic metastases n=l) and two of them without evidence of disease, one only but after repeated hepatic surgery. The survival data was well comparable with the survival data for resection of colorectal metastases (n=120), but better than the survival of other non colorectal metastases in this database (n=17).

Conclusion: Liver resection of metastases of soft tissue sarcomas can be performed safely and may prolong survival in patients with STS and reach at least as good overall survival figures as in patients with colorectal carcinomas.