Background: The role of liver resection for metastatic breast carcinoma is still debated. Methods: Fifty-one resected patients were reviewed. All patients received adjuvant chemotherapy after resection of the primary tumor. Clinicopathological characteristics and immunohistochemistry expression of estrogen (ER), progesterone (PR), human epidermal growth factor (HER2), or Ki67 were evaluated. Results: The median number of metastases was 2; single metastases were present in 24 (47%) patients. The median tumor diameter was 4 cm. Major hepatectomies were performed in 31 (61%) patients. Postoperative mortality was null. Postoperative morbidity was 13.7%. The 1-, 5-, and 10-year survival rates were 92, 36, and 16% respectively. Eleven (21.6%) patients survived longer than 5 years and 8.9% are alive without recurrence 10 years after surgery. At the univariate analysis, tumor diameter, lymph node status, PR receptor status, and triple positive receptors (ER+/PR+/Her2+) were significantly related to survival. At the multivariate analysis, tumor diameter, PR receptor, and triple negative status were significantly related to the long-term outcome. Conclusion: Liver resection seems to be a safe and effective treatment for metastases from breast cancer, and encouraging long-term survival can be obtained with acceptable risk in selected patients. Tumors less than 5 cm and positive hormone receptor status are the best prognostic factors.

Keywords:
Liver metastases, Liver resection, Outcome, Prognostic factors, Postoperative complications
1.
Jemal A, Bray F, Center MM, et al: Global cancer statistics. CA Cancer J Clin 2011; 61: 69–90.
2.
Redig AJ, McAllister SS: Breast cancer as a systemic disease: a view of metastasis. J Inter Med 2013; 274: 113–126.
3.
Solomayer EF, Diel IJ, Meyberg GC, Gollan C, Bastert G: Metastatic breast cancer: clinical course, prognosis and therapy related to the first site of metastasis. Breast Cancer Res Treat 2000; 59: 271–278.
4.
Largillier R, Ferrero JM, Doyen J, Barriere J, Namer M, Mari V, Courdi A, Hannoun-Levi JM, Ettore F, Birtwisle-Peyrottes I, Balu-Maestro C, Marcy PY, Raoust I, Lallement M, Chamorey E: Prognostic factors in 1,038 women with metastatic breast cancer. Ann Oncol 2008; 19: 2012–2019.
5.
Wyld L, Gutteridge E, Pinder SE, James JJ, Chan SY, Cheung KL, Robertson JF, Evans AJ: Prognostic factors for patients with hepatic metastases from breast cancer. Br J Cancer 2003; 89: 284–290.
6.
Elias D, Di Pietroantonio D: Surgery for liver metastases from breast cancer. HPB (Oxford) 2006; 8: 97–99.
7.
Pagani O, Senkus E, Wood W, Colleoni M, Cufer T, Kyriakides S, Costa A, Winer EP, Cardoso F: International guidelines for management of metastatic breast cancer: can metastatic breast cancer be cured? J Natl Cancer Inst 2010; 102: 456–463.
8.
Hoffmann K, Franz C, Hinz U, Schirmacher P, Herfarth C, Eichbaum M, Buchler MW, Schemmer P: Liver resection for multimodal treatment of breast cancer metastases: identification of prognostic factors. Ann Surg Oncol 2010; 17: 1546–1554.
9.
O’Shaughnessy J: Extending survival with chemotherapy in metastatic breast cancer. Oncologist 2005; 10(suppl 3):20–29.
10.
Yoo TG, Cranshaw I, Broom R, Padanaboyana S, Bartlett A: Systematic review of early and long-term outcome of liver resection for metastatic breast cancer: is there a survival benefit? Breast 2017; 32: 162–172.
11.
Hanrahan EO, Broglio KR, Buzdar AU, Theriault RL, Valero V, Cristofanilli M, Yin G, Kau SW, Hortobagyi GN, Rivera E: Combined-modality treatment for isolated recurrences of breast carcinoma: update on 30 years of experience at the University of Texas M.D. Anderson cancer Center and assessment of prognostic factors. Cancer 2005; 104: 1158–1171.
12.
Ercolani G, Grazi GL, Ravaioli M, Ramacciato G, Cescon M, Varotti G, Del gaudio M, Vetrone G, Pinna AD: The role of liver resection for noncolorectal, noneuroendocrine metastases: experience with 142 observed cases. Ann Surg Oncol 2005; 12: 459–466.
13.
Weitz J, Blumgart LH, Fong Y, Jarnagin WR, D’Angelica M, Harrison LE, DeMatteo RP: Partial hepatectomy for metastases from noncolorectal, noneuroendocrine carcinoma. Ann Surg 2005; 241: 269–276.
14.
Sakamoto Y, Yamamoto J, Yoshimoto M, Kasumi F, Kosuge T, Kokudo N, Makuuchi M: Hepatic resection for metastatic breast cancer: prognostic analysis of 34 patients. W J Surg 2005; 29: 524–527.
15.
Adam R, Cliché L, Aloia T, Elias D, Salmon R, Rivoire M, Jaeck D, Saric J, Le Treut YP, Belghiti J, Mantion G, Mentha G: Hepatic resection for noncolorectal nonendocrine liver metastases. Analysis of 1,452 patients and development of a prognostic model. Ann Surg 2006; 244: 524–535.
16.
Reddy SK, Barbas AS, Marroquin CE, Morse MA, Kuo PC, Clary BM: Resection of noncolorectal nonneuroendocrine liver metastases: a comparative analysis. J Am Coll Surg 2007; 204: 372–382.
17.
O’Rourke TR, Tekkis P, Yeung S, Fawcett J, Lynch S, Strong R, Wall D, John TG, Welsh F, Rees M: Long term results of liver resection for non-colorectal noneuroendocrine metastases. Ann Surg Oncol 2008; 15: 207–218.
18.
Groeschl RT, Nachmany I, Steel JL, Reddy SK, Glazer ES, De Jong MC, Pawlik TM, Geller DA, Tsung A, Marsh JW, Clary BM, Curley SA, Gamblin TC: Hepatectomy for noncolorectal non-neuroendocrine metastatic cancer: a multi-institutional analysis. J Am Coll Surg 2012; 214: 769–777.
19.
Pocard M, Pouillart P, Asselain B, Falcou MC, Salmon RJ: [Hepatic resection for breast cancer metastases: results and prognosis (65 cases)]. Ann Chir 2001; 126: 413–420.
20.
Elias D, Maisonnette F, Druet-Cabanac M, Ouellet JF, Guinebretiere JM, Spielmann M, Delaloge S: An attempt to clarify indications for hepatectomy for liver metastases from breast cancer. Am J Surg 2003; 185: 158–164.
21.
Adam R, Aloia T, Krissat J, Bralet MP, Paule B, Giacchetti S, Delvart V, Azoulay D, Bismuth H, Castaing D: Is liver resection justified for patients with hepatic metastases from breast cancer? Ann Surg 2006; 244: 897–907.
22.
Abbott DE, Brouquet A, Mittendorf EA, Andreou A, Meric-Bernstam F, Valero V, Green MC, Kuerer HM, Curley SA, Abdalla EK, Hunt KK, Vauthey JN: Resection of liver metastases from breast cancer: estrogen receptor status and response to chemotherapy before metastasectomy define outcome. Surgery 2012; 151: 710–716.
23.
Kostov DV, Kobakov GL, Yankov DV: Prognostic factors related to surgical outcome of liver metastases of breast cancer. J Breast Cancer 2013; 16: 184–192.
24.
Mariani P, Servois V, De Rycke Y, Bennett SP, Feron JG, Almubarak MM, Reyal F, Baranger B, Pierga JY, Salmon RJ. Liver metastases from breast cancer: surgical resection or not? A case-matched control study in highly selected patients. Eur J Surg Oncol 2013; 39: 1377–1383.
25.
Bacalbasa N, Dima SO, Purtan-Pumichescu R, Herlea V, Popescu I: Role of surgical treatment in breast cancer liver metastases: a single center experience. Anticancer Res 2014; 34: 5563–5566.
26.
Sadot E, Lee Y, Sofocleous C, et al: Hepatic resection or ablation for isolated breast cancer liver metastasis: A case-control study with comparison to medically treated patients. Ann Surg 2016; 264: 147–154.
27.
Onitilo AA, Engel JM, Greenlee RT, Mukesh BN: Breast cancer subtypes based on ER/PR and HER2 expression: comparison of clinicopathologic features and survival. Clin Med Res 2009; 7: 4–13.
28.
Oakman C, Viale G, Di Leo A: Management of triple negative breast cancer. Breast 2010; 19: 312–321.
29.
Ercolani G, Ravaioli M, Grazi GL, Cescon M, Del Gaudio M, Vetrone G, Zanello M, Pinna AD. Use of vascular clamping in hepatic surgery: lessons learned from 1260 liver resections Arch Surg 2008; 143: 380–387; discussion 388.
30.
Strasberg S, Belghiti J, Clavien PA: The Brisbane 2000 terminology of liver anatomy and resections. HPB 2000; 2: 333–339.
31.
Neri F, Ercolani G, di Gioia P, Del gaudio M, Pinna AD: Liver metastases from non-gastrointestinal non-neuroendocrine tumours: review of the literature. Updates Surg 2015; 67: 223–233.
32.
Chua TC, Saxena A, Liauw W, Chu F, Morris DL: Hepatic resection for metastatic breast cancer: a systematic review. Eur J Canc 2011; 47: 2282–2290.
33.
Howlader M, Heaton N, Rea M: Resection of liver metastases from breast cancer: towards a management guideline. Int J Surg 2011; 9: 285–291.
34.
Spolverato G, Vitale A, Bagante F, et al: Liver resection for breast cancer liver metastases: a cost-utility analysis. Ann Surg 2017; 265: 792–799.
© 2018 S. Karger AG, Basel
2018
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.